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- 2. BRACHIAL PLEXUS Dr. Alam Zeb AmiR DPT(KMU),MSPT(KMU) alamzebamir92@gmail.com
- 4. Spinal Nerve
- 7. • Formed in posterior triangle of neck • Anterior rami of C5, C6, C7, C8 & T1 FORMATION
- 8. • Roots • Trunks • Divisions • Cords • Branches BRANCHES
- 9. FORMATION OF THE BRACHIAL PLEXUS • Roots • The ventral rami of spinal nerves C5 to T1 are referred to as the roots of the plexus. • Trunks • Shortly after emerging from the intervertebral foramina , these 5 roots unite to form three trunks. • The ventral rami of C5 & C6 unite to form the Upper Trunk. • The ventral ramus of C 7 continues as the Middle Trunk. • The ventral rami of C 8 & T 1 unite to form the Lower Trunk.
- 10. FORMATION OF THE BRACHIAL PLEXUS • Divisions • Each trunk splits into an anterior division and a posterior division. • The anterior divisions usually supply flexor muscles • The posterior divisions usually supply extensor muscles • Cords • The anterior divisions of the upper and middle trunks unite to form the lateral cord. • The anterior division of the lower trunk forms the medial cord. • All 3 posterior divisions from each of the 3 cords all unite to form the posterior cord. • The cords are named according to their position relative to the axillary artery
- 11. FORMATION OF THE BRACHIAL PLEXUS • Terminal branches: • Musculo Cutaneous Nerve • Ulnar Nerve • Median Nerve • Axillary Nerve • Radial Nerve
- 13. • Anterior rami of spinal nerves C5, C6, C7, C8 & T1 • May get contributions from C4 & T2 • Origin may shift one segment above or below • Prefixed & post flexed plexus • Roots join to form trunks ROOTS
- 15. • Dorsal scapular nerve (nerve to rhomboids) C5 • Long thoracic nerve (nerve to serratus anterior) C5, C6, C7 BRANCHES OF THE ROOTS
- 16. Location of Brachial plexus
- 18. Relations of Brachial plexus
- 19. Relation with Axillary Artery
- 20. • Sensory innervation to skin & joints • Motor to muscles • Sympathetic vasomotor nerves • Sympathetic secretomotor supply to sweat glands FUNCTIONS
- 21. • Root C5 and C6 unite to form the upper trunk • Root C7 continues as middle trunk • Root C8 & T1 unite to form lower trunk • Each trunk divides into anterior & posterior divisions TRUNKS & DIVISIONS
- 23. • Arises only from the upper trunk • Suprascapular nerve C5 C6 (supplies supraspinatus ans infraspinatus) • Nerve to subclavius C5 C6 BRANCHES OF THE TRUNK
- 24. • Anterior division of upper & middle trunks unite to form lateral cord • Anterior division of lower trunk continues to form medial cord • Posterior division of all 3 trunks join to form posterior cord • The cords become arranged around the axillary artery in axilla • Here the plexus artery and vein are enclosed in axillary sheath CORDS
- 26. LATERAL CORD (C5-C7) • Lateral pectoral nerve • Musculocutaneous nerve • Lateral root of median nerve BRANCHES OF THE CORD
- 27. • Medial pectoral nerve • medial cutaneous nerve of arm & forearm • Medial root of median nerve • Ulnar nerve MEDIAL CORD (C8-T1)
- 28. • Upper & lower subscapular nerve C5 C6 • Nerve to lattismus dorsi (thoracodorsal nerve) C6 C7 C8 • Lower subscapular C5 C6 • Axillary C5 C6 • Radial C5-C8, T1 POSTERIOR CORD
- 31. • Erb's palsy (Erb-Duchenne Palsy) is a paralysis of the arm caused by injury to the upper trunk. Roots Involved: C5 and C6 Muscles Atrophy: Shoulder Arm Sensory Loss: Lateral aspect of Upper Limb • the arm hangs by the side and is rotated medially; the forearm is extended and pronated. commonly called "waiter's tip hand or policeman’s tip" Erb’s palsy
- 32. • klumpke's paralysis is a partial palsy of the lower roots of the brachial plexus. Roots Involved: C8 and T1 Clinical Appearance: Motor Loss: Small muscles of Hand Sensory Loss: Medial aspect of Upper Limb • The classic presentation of klumpke's palsy is the “claw hand” Klumpke’s palsy
- 34. MNEMONICS 1. Brachial Plexus: RTDCB: Roots , Trunks, Divisions, Cords, Branches 2. Main nerves : MARMU: Musculocutaneous , Axillary, Radial, Median, Ulnar 3. Branches of Posterior cord : ULTRA * Upper subscapular nerve * Lower subscapular nerve * Thoracodorsal nerve / Nerve to Latissimus Dorsi * Radial nerve * Axillary nerve 4. Branches of Lateral cord : LML * Lateral pectoral nerve * Musculocutaneous nerve * Lateral root of median nerve 5. Branches of Medial Cord : M4U * Medial Pectoral nerve * Medial Cutaneous Nerve of Arm * Medial Cutaneous Nerve of Forearm * Medial root of Median Nerve * Ulnar Nerve
- 35. How to draw the brachial plexus
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Editor's Notes
- Terminal Branches are mixed nerves containing both sensory and motor axons. Musculocutaneous nerve is derived from the lateral cord. This nerve innervates the muscles in the flexor compartment of the arm Carries sensation from the lateral ( radial) side of the forearm. (Figs. 2,3) Ulnar nerve is derived from the medial cord Motor innervation is mainly to intrinsic muscles of the hand Sensory innervation is from the medial ( ulnar) 1 & 1/2 digits ( the 5th. and 1/2 of the 4th. digits). (Figs. 2,3) Median nerve is derived from both the lateral and medial cords Motor innervation is to most of the flexors muscles in the forearm and intrinsic muscles of the thumb (thenar muscles). Sensory innervation is from the lateral ( radial) 3 & 1/2 digits ( the thumb and first 2 and 1/2 fingers). (Figs. 2,3) Axillary nerve is derived from the posterior cord. Motor innervation is deltoid and teres minor muscles that act on the shoulder joint. Sensory innervation is from the skin just below the point of the shoulder. (Figs. 2,3) Radial nerve is also derived from the posterior cord. Called “Great Extensor Nerve” because it innervates the extensor muscles of the elbow, wrist and fingers. Sensory innervation is from the skin on the dorsum of the hand on the radial side. (Figs. 2,3)
- BRANCHES (Fig. 4) Nerves that are branches from portions of the brachial plexus usually contain only 1 type of axon; either sensory or motor) From the Roots Dorsal Scapular nerve Derived from C5 root Motor nerve to the Rhomboideus major and minor muscles Long Thoracic nerve Derived from C 5,6,7 Innervates the serratus anterior muscle From the Upper Trunk Nerve to subclavius muscle Suprascapular nerve Innervates supra and infraspinatus muscles From the Lateral Cord Lateral Pectoral nerve Innervates the clavicular head of the pectoralis major muscle From the Medial Cord Medial Pectoral nerve Innervates the sternocostal head of the pectoralis major muscle Innervates the pectoralis minor muscle Note : the medial and lateral pectoral nerve often join together to act as a single nerve innervating both the pectoralis major & minor muscles Cutaneous Branches Medial brachial cutaneous Carries sensation from the lower medial portion of the arm Medial antebrachial cutaneous Carries sensation from the medial (ulnar portion of the forearm)
- Pectoralis minor is the land mark where divisions turn into cords, cords are related to the axillary artery “ medial, lateral, and posterior to the axillary artery
- where the forearm is supinated and the wrist and fingers are hyperextended with flexion at interphalangeal and metatarso phalangeal joints.