cervical and brachial plexus

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This ppt will bring to understanding of cervical and brachial plexus.

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cervical and brachial plexus

  1. 1. ANATOMY MUSKULOSKELETAL Cervical Plexus and Brachial Plexus By : Hermizan Halihanafiah COLLEGE OF ALLIED HEALTH AND SCIENCES
  2. 2. The Spinal Nerves <ul><li>31 pairs of spinal nerves (1st cervical above C1) </li></ul><ul><ul><li>mixed nerves exiting at intervertebral foramen </li></ul></ul><ul><li>Proximal branches </li></ul><ul><ul><li>Dorsal (posterior) root is sensory input to spinal cord </li></ul></ul><ul><ul><li>Ventral (anterior) root is motor output of spinal cord </li></ul></ul><ul><li>Distal branches </li></ul><ul><ul><li>dorsal ramus supplies dorsal body muscle and skin </li></ul></ul><ul><ul><li>ventral ramus to ventral skin and muscles and limbs </li></ul></ul><ul><ul><li>meningeal branch to meninges, vertebrae and ligaments </li></ul></ul>
  3. 3. Branches of a Spinal Nerve <ul><li>Spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. </li></ul><ul><li>Each has dorsal and ventral ramus . </li></ul>
  4. 7. <ul><li>Notice the branching and merging of nerves in this example of a plexus </li></ul>
  5. 8. Nerve Plexuses <ul><li>Ventral rami branch and anastomose repeatedly to form 5 nerve plexuses </li></ul><ul><ul><li>cervical plexus </li></ul></ul><ul><ul><li>brachial plexus </li></ul></ul><ul><ul><li>Lumbar plexus </li></ul></ul><ul><ul><li>Sacral plexus </li></ul></ul><ul><ul><li>Coccygeal plexus </li></ul></ul>
  6. 9. Spinal Nerve Roots and Plexuses
  7. 10. Nerves Plexuses <ul><li>The ventral (anterior) rami of spinal nerves, except for thoracic nerves T2-T12, do not go directly to the body structures they supply. </li></ul><ul><li>They form networks on the both the left and right sides of the body by joining with various numbers of axons from anterior rami of adjacent nerves. </li></ul><ul><li>Ventral rami branch and anastomose repeatedly to form 5 nerve plexuses </li></ul>
  8. 11. Nerves Plexus <ul><li>The principal plexuses are: </li></ul><ul><ul><li>Cervical plexus </li></ul></ul><ul><ul><li>Brachial plexus </li></ul></ul><ul><ul><li>Lumbar plexus </li></ul></ul><ul><ul><li>Sacral plexus </li></ul></ul><ul><ul><li>Cocygeal plexus </li></ul></ul>
  9. 12. Cervical Plexus <ul><li>Formed by the anterior (ventral) rami of the cervical nerves C1-C4 with contribution C5. </li></ul><ul><li>Supplies the skin and muscles of the head, neck and superior part of the shoulders and chest. </li></ul><ul><li>Phrenic nerves arise from the cervical, innervate for the diaphragm muscles. </li></ul>
  10. 13. The Cervical Plexus
  11. 15. Terminal Branches <ul><li>Superficial branches (Sensory) </li></ul><ul><li>Lesser occipital (C2) – skin of scalp posterior and superior to ear. </li></ul><ul><li>Great auricular (C2-C3) – skin anterior, inferior, and over ear and over parotid gland. </li></ul><ul><li>Transverse cervical (C2-C3) – skin over anterior aspect of neck. </li></ul><ul><li>Supraclavicular (C3-C4) – skin over superior portion of chest and shoulder. </li></ul>
  12. 16. Transverse Cervical nerve C2,C3 Supraclavicular nerve C2, C3 Greater Auricular nerve C2,C3 Lesser occipital nerve C2 (ventral rami) Greater occipital nerve C2 (dorsal rami)
  13. 17. <ul><li>Deep Branches (Motor) </li></ul><ul><li>Ansa cervicalis (superior root) – infrahyoid and geniohyoid muscles of the neck. </li></ul><ul><li>Ansa cervicalis (inferior root) – infrahyoid muscles of neck. </li></ul><ul><li>Phrenic nerve – diaphragm </li></ul><ul><li>Segmental branches – prevertebral muscles of the neck, levator scapulae and middle fiber of scalene. </li></ul>Terminal Branches
  14. 18. Brachial Plexus <ul><li>The anterior (ventral) rami of spinal nerves C5-C8 and T1 form the brachial plexus. </li></ul><ul><li>Extends inferiorly and laterally on either side of the last four cervical and first thoracic vertebrae through intervetebral foramen. </li></ul><ul><li>Passes above the first rib posterior to the clavicle and then enter the axilla (cervicoaxillary canal). </li></ul><ul><li>The brachial plexus provide the entire nerve supply of the shoulder and upper limbs. </li></ul>
  15. 19. <ul><li>Five important nerves arise from brachial plexus are: </li></ul><ul><ul><li>Axillary nerve </li></ul></ul><ul><ul><li>Musculocutaneous nerve </li></ul></ul><ul><ul><li>Radial nerve </li></ul></ul><ul><ul><li>Median nerve </li></ul></ul><ul><ul><li>Ulnar nerve </li></ul></ul>Brachial Plexus
  16. 20. Nerve Supply <ul><li>The nerve that supplying the structures in the arm are all derivative from the brachial plexus. </li></ul><ul><li>Brachial plexus is a complex of intermingling nerves that originate from the neck (cervical and thoracic origin) </li></ul>
  17. 22. <ul><li>Brachial plexus is formed by the ventral (anterior) rami of the lower cervical nerves and the first thoracic nerves. (C5, C6, C7, C8, T1) </li></ul><ul><li>Occasionally, there maybe a contribution from C4 or T2 or both. </li></ul>Nerve Supply
  18. 25. Brachial Plexus <ul><li>The anterior (ventral) rami of spinal nerves C5-C8 and T1 form the brachial plexus. </li></ul><ul><li>Extends inferiorly and laterally on either side of the last four cervical and first thoracic vertebrae. </li></ul><ul><li>Passes above the first rib posterior to the clavicle and then enter the axilla (passes through cervicoaxillary canal). </li></ul>
  19. 26. <ul><li>The brachial plexus provide the entire nerve supply of the shoulder and upper limbs. </li></ul><ul><li>Five important nerves arise from brachial plexus are: </li></ul><ul><ul><li>Axillary nerve </li></ul></ul><ul><ul><li>Musculocutaneous nerve </li></ul></ul><ul><ul><li>Radial nerve </li></ul></ul><ul><ul><li>Median nerve </li></ul></ul><ul><ul><li>Ulnar nerve </li></ul></ul>Brachial Plexus
  20. 27. Levels of Brachial Plexus <ul><li>R oots </li></ul><ul><li>T runks </li></ul><ul><li>D ivisions </li></ul><ul><li>C ords </li></ul><ul><li>B ranches </li></ul><ul><li>R eal </li></ul><ul><li>T rainers </li></ul><ul><li>D rink </li></ul><ul><li>C old </li></ul><ul><li>B eer </li></ul>
  21. 30. Roots <ul><li>The five roots are the five anterior(ventral) rami of the spinal nerves, after they have given off their segmental supply to the muscles of the neck. </li></ul><ul><li>These roots merge to form three trunks : </li></ul><ul><ul><li>&quot;superior&quot; or &quot;upper&quot; (C5-C6) </li></ul></ul><ul><ul><li>&quot;middle&quot;(C7) </li></ul></ul><ul><ul><li>&quot;inferior&quot; or &quot;lower&quot; (C8-T1) </li></ul></ul>
  22. 31. Trunk <ul><li>Each trunk then splits in two, to form six divisions : </li></ul><ul><ul><li>anterior division of the upper, middle and lower trunks </li></ul></ul><ul><ul><li>posterior division of the upper, middle, and lower trunks </li></ul></ul>
  23. 32. Division and Cords <ul><li>These six divisions will regroup to become the three cords . The cords are named by their position in respect to the axillary artery. </li></ul><ul><ul><li>The posterior cord is formed from the three posterior divisions of the trunks (C5-T1) </li></ul></ul><ul><ul><li>The lateral cord is the anterior divisions from the upper and middle trunks (C5-C7) </li></ul></ul><ul><ul><li>The medial cord is simply a continuation of the anterior division of the lower trunk (C8-T1) </li></ul></ul>
  24. 34. Spesific Branches <ul><li>One can remember the specific branches of lateral, posterior and medial cord using the mnemonic LML, ULNAR , M4U respectively. </li></ul><ul><li>LML - lateral pectoral nerve , musculocutaneous nerve , lateral root of the median nerve. </li></ul><ul><li>ULNAR - upper subscapular nerve , lower subscapular nerve , nerve to latissmus dorsi (thoracodorsal nerve) , axillary nerve , radial nerve. </li></ul><ul><li>M4U - medial pectoral nerve , medial root of the median nerve , medial cutaneous nerve of the arm , medial cutaneous nerve of the forearm , ulnar nerve. </li></ul>
  25. 36. Learn the Brachial Plexus in Five Minutes or Less!!
  26. 37. Draw two headless arrows to the right.
  27. 38. Add a headless arrow to the left
  28. 39. Add a “W “
  29. 40. Add an “X”
  30. 41. Add a “Y”. (Just a branch of the “Y”is added.)
  31. 42. Label C5 to T1 .
  32. 43. Label the major branches:
  33. 44. More complex diagramming of the brachial plexus includes the four “3s .”
  34. 45. The first “3”is the branches to C5, 6, and 7 which form LTN = long thoracic nerve.
  35. 46. Next, each of the headless arrows has three nerves attached to it.To the top headless arrow, add its “3.”
  36. 47. Label these “3”:DSN = dorsoscapular nerve; SS = suprascapular nerve;LP = lateral pectoral nerve
  37. 48. Add the “3”to the middle headless arrow.
  38. 49. Label the second headless arrow “3”: SS = subscapular, TD = thoracodorsal nerve.
  39. 50. Add the final “3”on the bottom headless arrow
  40. 51. *Label the last “3.”MP = medial pectoral,MBC = medial brachial cutaneous, and MABC = medial antebrachial cutaneous. *Remember: the brachial cutaneous goes to the brachium or arm, and the MABC goes to the antebrachium or forearm.
  41. 52. Label roots, trunks, divisions, cords, terminal branches .
  42. 53. Radiologists, neurosurgeons and thoracic surgeons need to know the nerve to the subclavius(SUB).
  43. 54. The complete brachial plexus diagram
  44. 56. Supraspinatus, infraspinatus C6, C6 Suprascapular Superior trunk Subclavius C5, C6 Subclavian Superior trunk Serratus anterior C5, C6, C7 Long thoracic Roots Rhomboid minor, major and levator scapulae C5 Dorsal scapular Roots Muscles Root Nerve From
  45. 57. Muscles Root Nerve From Subscapularis C5, C6 Upper subcsapular nerve Posterior cord Fibers to the median nerve C5. C6, C7 Lateral root of the median nerve Lateral cord Coracobrachialis, brachialis, biceps brachii C5. C6, C7 Musculocutaneous nerve Lateral cord Pectoralis major C5. C6, C7 Lateral pectoral nerve Lateral cord
  46. 58. Triceps brachii, supinator, anconeus, extensor muscles move the hand, brachioradialis C5-C8, T1 Radial nerve Posterior cord Anterior branch: Deltoid Posterior branch: Teres minor C5, C6 Axillary nerve Posterior cord Subscapularis C5, C6 Lower subscapular Posterior cord Latissimus dorsi C6, C7, C8 Thoracodorsal nerve Posterior cord Muscles Root Nerve From
  47. 59. Skin of medial and posterior aspects of forearm C8, T1 Medial cutaneous nerve of the forearm (medial antebrachial cutaneous) Medial cord Skin of medial and posterior aspect of distal third of arm C8, T1 Medial cutaneous nerve of the arm (medial brachial cutaneous) Medial cord Fibers to the median nerve C8, T1 Medial root of median nerve Medial cord Pectoralis major, Pectoralis minor C8, T1 Medial pectoral nerve Medial cord Muscles Root Nerve From
  48. 60. Flexor carpi ulnaris, flexor digitorum profundus, most of the small muscles of the hand C8, T1 Ulnar nerve Medial cord Muscles Root Nerve From
  49. 61. Summary <ul><li>Branches from the roots </li></ul><ul><li>Nerves to the scalene and longus colli (C5, 6, 7, 8) </li></ul><ul><li>A branch to the phrenic nerve (C5) </li></ul><ul><li>Dorsal scapular nerve (C5) </li></ul><ul><li>Long thorasic nerve (C5, 6, 7) </li></ul><ul><li>Branches from the trunks </li></ul><ul><li>Nerve to subclavius / subclavian nerve (C(4), 5, 6) </li></ul><ul><li>Suprascapular nerve (C(4), 5, 6) </li></ul><ul><li>There are no nerves arising from the divisions </li></ul>
  50. 62. <ul><li>Branches from the cords of the plexus </li></ul><ul><li>Medial cord </li></ul><ul><li>Medial pectoral nerve (C8, T1) </li></ul><ul><li>Medial brachial cutaneous nerve (T1) </li></ul><ul><li>Medial antebrachial cutaneous nerve (C8, T1) </li></ul><ul><li>Ulnar nerve (C(7), 8, T1) </li></ul><ul><li>Medial part of the median nerve (C8, T1) </li></ul>Summary
  51. 63. <ul><li>Branches from the cords of the plexus </li></ul><ul><li>ii. Posterior cord </li></ul><ul><li>Upper subscapular nerve (C(4), 5, 6, (7)) </li></ul><ul><li>Thoracodorsal nerve (C(5), 7. 8) </li></ul><ul><li>Lower subscapular nerve (C5, 6) </li></ul><ul><li>Axillary nerve (C5, 6) </li></ul><ul><li>Radial nerve (C5, 6) </li></ul>Summary
  52. 64. <ul><li>Branches from the cords of the plexus </li></ul><ul><li>iii. Lateral cord </li></ul><ul><li>Lateral pectoral nerve (C5, 6, 7) </li></ul><ul><li>Musculocutaneous nerve (C5, 6, 7) </li></ul><ul><li>Lateral part of the median nerve (C(5), 6, 7)) </li></ul>Summary
  53. 65. Thank You For Your Attention !!!

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