1.nervii periferici ai membrului superior


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1.nervii periferici ai membrului superior

  2. 2. 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
  3. 3. Plexul brahial 5 nervi principali provin din plexul brahial: 1. 2. 3. 4. 5. Nervul axilar Nervul musculocutanat Nervul radial Nervul Median Nervul ulnar
  4. 4. Plexul brahial
  5. 5. 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
  6. 6. Dermatoam / miotom
  7. 7. 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)
  8. 8. Nervul axilar • Din radacinile C5-C6 • Provine din fasciculul posterior al plexului brahial de la nivelul axilei.
  9. 9. 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
  10. 10. 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
  11. 11. 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.
  12. 12. Nervul cutanat brahial lateral (nervul axilar)
  13. 13. 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.
  14. 14. 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
  15. 15. 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
  16. 16. Nervul Radial • Provine din fasciculul posterior al plexului brahial • Se formeaza din radacinile ventrale C5, C6, C7, C8 & T1.
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. Radial Nerve Dermatomes
  22. 22. Radial Nerve • Motor innervations • Triceps brachii, anconeus, brachioradialis, supinator and mostly posterior compartment extrinsic hand muscles.
  23. 23. 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.
  24. 24. Wrist Dropped
  25. 25. Fracture of the humerus
  26. 26. 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.
  27. 27. 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))
  28. 28. 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)
  29. 29. Hand Dermatomes
  30. 30. 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.
  31. 31. Claw Hand Deformities
  32. 32. 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 .
  33. 33. • 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
  34. 34. 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
  35. 35. Median nerve dermatomes
  36. 36. 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)
  37. 37. 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 –
  38. 38. 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
  39. 39. 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)
  40. 40. Erb’s Duchenne Palsy • This posture occurs because of paralysis and atrophy of: • Deltoid • Biceps brachii • Brachialis • brachioradialis
  41. 41. 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