BRACHIAL PLEXUS BRACHILAL PLEXUS The brachial plexus is

BRACHIAL PLEXUS

BRACHILAL PLEXUS • The brachial plexus is a somatic nerve plexus formed by intercommunications among the ventral rami of the lower four cervical nerves ( C 5 - C 8) and the first thoracic nerve (T 1). • The plexus is responsible for the motor innervation to all of the muscles of the upper limb with the exception of the trapezius and levator scapula. ) • sensory innervation of the upper limb

SPINAL NERVES 31 pairs of spinal nerves are attached to the spinal cord 8 Cervical 12 Thoracic 5 lumbar 5 sacral 1 coccygeal

SPINAL NERVES Dorsal branch Spinal nerve Ventral branch

BRACHIAL PLEXUS It is a network of nerves which supplies upper limb. Formed - ventral rami (branches) of C 5 – C 8 & T 1 spinal nerves. Origin - neck, passes laterally & enters the axilla.

BRACHIAL PLEXUS ROOTS TRUNKS DIVISIONS CORDS BRANCHES

PARTS SUPRACLAVICULAR PART Roots , trunks and divisions INFRACLAVICULAR PART Cords and branches

Relations of Brachial plexus

FORMATION. Roots Union of ventral rami of C 5, C 6, C 7, C 8&T 1 C 5 receives contribution from. C 4. T 1 receives contribution from T 2 PREFIXED: C 4 contribution is large and T 1 root is small POSTFIXED: T 2 contribution is large and C 5 root will be small

Roots Combine Forming Trunks Which Then Split Into Divisions C 5 Anterior Division Upper Trunk C 6 Posterior Division Anterior Division C 7 Middle Trunk Posterior Division C 8 Anterior Division Lower Trunk T 1 Posterior Division

Divisions Form Cords Upper Middle Lower Anterior Lateral Cord Posterior Anterior Medial Cord Posterior Anterior Posterior Cord

NKS UPPER TRUNK Union of C 5 and C 6 MIDDLE TRUNK Only C 7 LOWER TRUNK Union of C 8 and T 1

CORDS DIVISIONS TRUNKS ROOTS C 5 LATERAL UPPER C 6 POSTERIOR MIDDLE C 7 C 8 MEDIAL LOWER T 1

DIVISIONS Each trunk divides into an posterior divisions. anterior and

CORDS LATERAL CORD: Union of anterior divisions of upper and middle trunks MEDIAL CORD: Anterior division of lower trunk POSTERIOR CORD: Union of Posterior divisions of upper, middle and lower trunks

Brachial Plexus Cleyson Mupfiga HUB 117 2011 18

BRANCHES FROM ROOTS 1. Long thoracic nerve(C 5, C 6&C 7) 2. Dorsal scapular nerve(C 5) 3. Branch to phrenic nerve(C 5) FROM TRUNK (ONLY FROM THE UPPER TRUNK- ERB`S POINT) 1. Suprascapular nerve(C 5, 6) 2. Nerve to subclavius(C 5, 6)

MUSCULAR SUPPLY ROOTS Dorsal scapular nerve-Rhomboides major and minor Long thoracic nerve-Serratus anterior Phrenic nerve-Diaphragm

MUSCULAR SUPPLY TRUNK Suprascapular nerve - supraspinatus and infraspinatus Nerve to subclavius-subclavius

FROM CORDS LATERAL CORD: 1. Lateral pectoral nerve(C 5, 6, 7) 2. Musculocutaneous nerve(C 5, 6, 7) 3. Lateral root of median nerve(C 5, 6, 7)

FROM CORDS MEDIAL CORD: 1. Medial pectoral nerve [C 8, T 1] 2. Medial cutaneous nerve of arm [C 8, T 1] 3. Medial cutaneous nerve of forearm [C 8, T 1] 4. Medial root of median nerve [C 8, T 1] 5. Ulnar nerve [C 7, C 8, T 1]

FROM CORDS POSTERIOR CORD: 1. Upper subscapular nerve (C 5, 6) 2. Thoracodorsal nerve (C 6, 7, 8) 3. Lower subscapular nerve (C 5, 6) 4. Axillary nerve (C 5, 6) 5. Radial nerve (C 5, 6, 7, 8 &T 1)

APPLIED ANATOMY Trauma compression Wounds in the neck or axilla Malignancy of breast

BRACHIAL PLEXUS INJURIES ERB`S PARALYSIS Site of injury: Erb`s point Injury to the upper trunk Cause of injury: Undue separation of the head and shoulder may be due to: 1. Birth injury (forceps delivery) 2. Fall on the shoulder 3. During anaesthesia

ERB`S PARALYSIS Nerve roots involved: C 5&C 6 Muscles paralysed: Biceps brachii, deltoid, brachialis, brachioradialis Deformity(Position of the limb): Arm: hangs by the side; it is adducted and medially rotated. Forearm: extended and pronated The deformity is called POLICEMAN`S TIP HAND OR PORTER`S TIP HAND

KLUMPKE`S PARALYSIS Site of injury: Lower trunk Cause of injury: Undue abduction of arm(fall from a height) or birth injury Nerve roots involved: Muscles paralysed: C 8, T 1 intrinsic muscles of hand, ulnar flexors of wrist and fingers Deformity: Claw hand

KLUMPKE’S PARALYSIS

CLAW HAND

INJURY TO LONG THORACIC NERVE Cause: Sudden pressure on the shoulder from above, carrying heavy loads on the shoulder. Paralysis of serratus anterior Deformity: Winging of scapula (excessive prominence of medial border of the scapula) Disability: Loss of pushing and punching actions Arm cannot be raised beyond 90 degrees.

• Winged scapular deformity • Caused by injury to long thoracic nerve of Bell (C 5, 6 and 7)

THANK YOU