The document discusses the brachial plexus, which is formed by the anterior rami of cervical and upper thoracic spinal nerves. It describes the roots, trunks, divisions, cords and branches of the brachial plexus. Common brachial plexus injuries are also summarized, including their causes, types, investigations, treatments, and specific injuries like Erb's palsy and Klumpke's paralysis.

1. BRACHIAL
PLEXUS
Aarushi Manu
50th Batch

2. Anatomy
 Roots
 Trunks
 Division
 Cord
 Branches
Sympathetic nerves of upper limb – T2
to T6 pass thru brachial plexus

3. Roots
 Ant. Primary rami of C5,6,7,8&T1
with cotribution from C4 & T2
 Prefixed or postfixed
Trunks
C5 & C6 upper trunk
C7 middle trunk
C8 & T1 lower trunk

4. Divisions
 Trunks divides into dorsal & ventral
divisions
Cords
Lateral cord – ventral division of upper
& middle trunks
Medial – ventral divisn of lower
trunk
posterior – dorsal division of all
trunks

5. Branches of Plexus
A. Branches of Roots
1.Long thoracic nerve – N to
serratus anterior (C5,6,7)
2. Dorsal scapular N. – N to
rhomboides (C5)
B. Branches of Trunks
1.Suprascapular N. (C5,6)
2. N. to subclavius (C5,6)

6. C.Branches of cords
(a) lateral cord
1. Lateral pectoral (C5-7)
2.Musculocutaneous(C5-7)
3.Lat. Root of median(C5-7)
(b) Medial cord
1.Medial pectoral (C8,T1)
2.Med. Cut. N. of arm(c8,T1)
3.Med. Cut. N. of forearm(C8,T1)

7. 4.Med. Root of median(C8,T1)
5.Ulnar N.(C7,C8,T1)
(c) Posterior cord
1.Upper subscapular(C5,6)
2.Lower subscapular(C5,6)
3.Axillary/circumflex(C5,6)
4.Thoracodorsal (C6,7,8)
N to latissmus dorsi
5.Radial N. (C5-8,T1)

9. Brachial Plexus Injuries
Causes
 Closed – birth trauma,bike trauma
 Open – gunshot
Types
 Preganglionic- Horners synd.
 Postganglionic

10. Investigation
 X-ray
 CT
 MRI
 Electrical studies – EMG,nerve
conductn study

11. Rx
Initial stages
1.Splinting
 Complete paralysis-Flail arm splint
 Incomplete – modified splints
2.pain control –TENS
3.Prevent contracture & deformities-
passive exercises

12. Later stages
1. Strengthen the ms-exercises,PNF
2. Re-educatn of ms-movt. Of
shoulder & stimulatn
3. Modify the splint & dynamise it
4. TENS for pain
5. Re-constructive surgery-after 2
yrs

13. Surgery
A/c phases
 preganglionic-no use
 postganglionic- suture or N.
grafting
Late phase >2yrs
 Shoulder fn- trapzius to humerus
to improve abductn
 Elbow fn- Steindler’s flexorplasy
 For wrist & finger extentn

14. Erb’s Palsy
 Site – Erb’s point
 Causes – Birth injury,Fall on
shoulder, Anaesthetia
 Nerve root – C5(mainly),C6(partly)
 Muscle paralysed-
biceps,deltoid,brachialis,
brachioradialis,supinator,supra-
&infraspinatus
 Deformity – policeman’s tip hand

16. Disability
 Abductn & lat. Rotatn of arm
 Flexion & supinatn of forearm
 Biceps & supinator jerks
 Sensatn over lower part of deltoid

17. Klumpke’s paralysis
 Cause –undue abductn of arm,birth
injury
 Nerve root- T1 & partly C8
 Muscles – intrinsic muscles of
hand(T1)& ulnar flexors of wrist and
hand(C8)
 Deformity – Claw hand

18. CLAW HAND

19.  Injury to N of Bell
winging of scapula

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