1.nervii periferici ai membrului superior
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1.nervii periferici ai membrului superior

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1.nervii periferici ai membrului superior 1.nervii periferici ai membrului superior Presentation Transcript

  • NERVII PERIFERICI AI MEMRULUI SUPERIOR
  • Plexul brahial • Retea de nervi spinali, formata din ramurile ventrale (ramurile anterioare) a nervilor spinali cervicali C5-C8 si nervul spinal toracal T1. • Plexul brahial este da ramuri cutanate (senzoriale) si musculare (motoare) care inerveaza membrul superior
  • Plexul brahial 5 nervi principali provin din plexul brahial: 1. 2. 3. 4. 5. Nervul axilar Nervul musculocutanat Nervul radial Nervul Median Nervul ulnar
  • Plexul brahial
  • Dermatoamele • Zona pielii care este inervata de un singur nerv spinal • zona de piele care furnizează informații senzoriale de la rădăcinile dorsale ale unei perechi de nervi spinali • Exista 8 nervi cervicali, 12 toracali, 12 toracali, 5 lombari si 5 sacrali ca relee senzoriale (durere, temperatura, mancarime , atingere) din fiecare regiune a coruplui la • Dermatoamele sunt utile in neurologie pentru a gasi nivelul leziunii coloanei vertebrale
  • Dermatoam / miotom
  • Dermatoamele capului • Nervul trigemen(pielea din regiunea antero-laterala a fetei) • Plexul cervical (pielea gatului si pavilionul urechii) • Nervii cervicali spinali– ramurile posterioare( pielea din regiunea posterioara a capului si gatului)
  • Nervul axilar • Din radacinile C5-C6 • Provine din fasciculul posterior al plexului brahial de la nivelul axilei.
  • Ramurile nervului axilar • Se afla posterior de artera axilara si anterior de muschiul subscapular • Apoi nervul axilar se divide intr-o ramura anterioara (ramura superioara) si o ramura posterioara (ramura inferioara) • Ramura anterioara inerveaza marginea anterioara a muschiului deltoid (fibrele anterioare si laterale ) • Ramura posterioara inerveaza rotundul mic si partea posterioara a muschiului deltoid (fibrele posterioare) Apoi se va ramifica pentru a forma nervul cutanat superior
  • Inervatia nervului axilar • Inervatia musculara -ramurile anterioare– fibrele anterioare si laterale ale muschiului deltoid -ramurile posterioare– rotund mic si fibrele posterioare ale muschiului deltoid Inervatia cutanata - Nervul cutanat superior si lateral -transporta informatia de la articulatia umarului - pielea acopera regiunea inferioara a muschiului deltoid
  • Cont.. • Frecvent lezat in dizlocatia umarului • Rezulta paralizia muschiului deltoid si rotund mic • Incapacitate de a abduce bratul, dincolo de fapul ca poate fi posibil prin actiunea supraspinosului 15 grade.
  • Nervul cutanat brahial lateral (nervul axilar)
  • Nervul Musculocutanat • Provine din fasciculul lateral al plexului brahial • De partea opusa a marginii inferioare a muschiului pectoral mic • Provine din radacinile ventrale C5, C6 and C7.
  • Nervul Musculocutanat • Strapunge coracobrahialul si trece oblic printre bicepsul brahial si brahial in partea laterala a bratului • Apoi se continua pe antebrat ca nervul cutanat antebrahial lateral
  • Inervatia nervului musculocutanat Inervatia musculara - Inerveaza coracobrahialul bicepsulbrahial si brahialul Inervatia cutanata – Nervul cutanat antebrahial lateral se divide intr-o ramura anterioara si una posterioara – Ramura anterioara – pielea suprafetei antero laterale a antebratului si a bazei degetului mare – Ramura posterioara – pielea suprafetei antero laterale a antebratului
  • Nervul Radial • Provine din fasciculul posterior al plexului brahial • Se formeaza din radacinile ventrale C5, C6, C7, C8 & T1.
  • Nervul Radial • El descinde oblic prin brat, prima data in compartimentul posteior al bratului, si lateral in compartimentul anterior al bratului • Nervul radial intra in brat in spatele arterei axilare si calatoreste posterior pe partea mediala a bratului
  • Nervul Radial • Apoi nervul radial inerveaza tricepsul brahial • Apo intra in santul nervului radial, dupa care intra in compartimentul anterior al bratului • El isi continua calatoria intre brahial si brahioradial • Cand nervul radia paraseste partea distala a humerusului, el trece anterior peste epicondilul lateral si se continua in antebrat
  • Nervul radial • In antebrat el da ramuri superficiale (senzoriale) si ramuri profunde (motorii) • Inervatia cutanata este data de nervi care provin din nervul radial – Nervul cutanat brahial posterior – Nervul cutanat brahial inferior lateral – Nervul cutanat antebrahial posterior – Ramuri superficiale ale nervului radial
  • Radial Nerve • Nervul cutanat posterior al bratului – furnizeaza inervatie senzoriala pentrr pielea posterioara a bratului • Inferior lateral cutaneous nerve of arm (inferior lateral brachial cutaneous) - provides sensory and vasomotor innervation to the lower, lateral aspect of the arm. • Posterior cutaneous nerve of forearm (posterior antebrachial cutaneous).-skin of the posterior of the forearm • Superficial branch – back of the hand
  • Radial Nerve Dermatomes
  • Radial Nerve • Motor innervations • Triceps brachii, anconeus, brachioradialis, supinator and mostly posterior compartment extrinsic hand muscles.
  • Cont… • The radial nerve is often injured in its course close to the humerus, either from fracture or pressure from direct blow to the humerus (incorrect use of a crutch) • Triceps usually escapes because derivation of the nerve giving off high in arm, but total paralysis of the extensor of the wrist and digits leads to the dropped wrist deformities.
  • Wrist Dropped
  • Fracture of the humerus
  • Ulnar Nerve • Arise from medial cord of brachial plexus • Root C8 and T1 (mostly C7) • Descend on the posteromedial of the humerus. • Then it goes posterior to the medial epicondyle.
  • Ulnar Nerve • Enter anterior compartment muscles of forearm and supplies flexor carpi ulnaris and medial half flexor digitorum profundus. • Then ulna nerve enter palm of the hand and branch off to the superficial branch and deep branch. • Deep branch innervate hypothenar muscles, intermediate hand muscles and thenar hand muscles (adductor pollicis, flexor pollicis brevis (rare))
  • Ulnar Nerve • Superficial branches of Ulnar nerve will innervate palmaris brevis and skin anterior and posterior of the hand (medial aspect of the hand/ one an half digits)
  • Hand Dermatomes
  • Cont… • Ulnar nerve may be damaged in the groove behind the medial epicondyle either by trauma or entrapment. • Leads to partial or completely lost of muscular and sensory innervations. • The results of the ulna nerve lesion leads to the typical ‘claw hand’ deformities. • Due to lost of the power in the intrinsic hand muscles and unopposed actions of antagonistic muscles group.
  • Claw Hand Deformities
  • Median Nerve • Arise from lateral root of lateral cord (C5,6,7) and medial root and medial cord (C8,T1) of brachial plexus. • Passes down the midline of the arm in close association with the brachial artery. • Passes in front of elbow joint (cubital fossa) then down to supply the muscles of the anterior of forearm. • Then it continue into the hand through carpal tunnel where it supply intrinsic hand muscles and skin of the hand .
  • • At the cubital fossa the anterior interosseous nerve arises from the median nerve • Descend through the forearm and end at the wrist by giving the articular branch to the radiocarpal and intercarpal joint. • It supplies flexor pollicis longus, lateral half flexor digitorum profundus and pronator quadratus
  • Median Nerve • Motor – all anterior (flexor) compartment of forearm (except flexor carpi ulnarisand ulnar half of the flexor digitorum profundus ),pronator teres & quadratus, intrinsic hand muscles (LOAF;1,2 lumbricals, OP, FPB, APB) • Sensory – skin of the palmar aspect of the thumb and the lateral 2 ½ fingers and the distal ends of the same fingers and skin of distal phalanx on same finger
  • Median nerve dermatomes
  • Cont… • Median nerve can be injured by deep cut with resultant lost of flexion at all IP joint except the distal ones in the ring and little finger. • MCP still can be flexed at this fingers ( lumbricals) • In the hand thumb is extend and adducted, lost of ability to abduct and oppose. • Compression at the carpal tunnel give rise the carpal tunnel syndrome (CTS)
  • Carpal Tunnel Syndrome • Compression median nerve at the carpal tunnel • Patient will experience numbness, tingling, or burning sensation at the thumb, index, middle and radial half of the ring finger. • If untreated –
  • Brachial Plexus Injury • Obstetric brachial plexus palsy • Injury to all or portion of a child brachial plexus occurring at that time of the delivery. • Excessive lateral traction on the head so that the head is pulled away from the shoulder. • Divide into : • Erb’s Duchenne Palsy
  • Erb’s Duchenne Palsy • Involving upper roots (C5, C6 and C7) • Affecting the musculature of the upper arm • Shows the “waiter tips” posture of the paralyze limb. • The arm lies medial rotation at the side of the chest • The elbow is extended (paralyzed C5, C6)
  • Erb’s Duchenne Palsy • This posture occurs because of paralysis and atrophy of: • Deltoid • Biceps brachii • Brachialis • brachioradialis
  • Klumpke’s Palsy • • • • Rare Involving lower root (C8 and T1) Affecting forearm and hand Characterize by paralysis and atrophy of the small hand muscles and flexor of the wrist. • Claw hand