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Cervical & Brachial Plexus
Dr. Rabia Inam Gandapore
Assistant Professor
Head of Department Anatomy
(Dentistry-BKCD)
B.D.S (SBDC), M.Phil. Anatomy (KMU),
Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE
(KMU),CHR (KMU), Dip. Arts (Florence, Italy)
Teaching Methodology
 LGF (Long Group Format)
 SGF (Short Group Format)
 LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams)
 SGD (Short Group)
 SDL (Self-Directed Learning)
 DSL (Directed-Self Learning)
 PBL (Problem- Based Learning)
 Online Teaching Method
 Role Play
 Demonstrations
 Laboratory
 Museum
 Library (Computed Assisted Learning or E-Learning)
 Assignments
 Video tutorial method
Goal/Aim (main objective)
To help/facilitate/augment the students about the:
 Enlist branches of cervical plexus
 Describe the formation of brachial plexus.
 Enlist the branches of brachial plexus.
Specific Learning Objectives (cognitive)
At the end of the lecture the student will able to:
 Enlist branches of cervical plexus
 Describe the formation of brachial plexus.
 Enlist the branches of brachial plexus.
Psychomotor Objective: (Guided response)
 A student to draw labelled diagram of the Cervical and Brachial Plexus
Affective domain
 To be able to display a good code of conduct and moral values in the class.
 To cooperate with the teacher and in groups with the colleagues.
 To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on time in the
class.
 To be able to perform well in the class under the guidance and supervision of the teacher.
 Study the topic before entering the class.
 Discuss among colleagues the topic under discussion in SGDs.
 Participate in group activities and museum classes and follow the rules.
 Volunteer to participate in psychomotor activities.
 Listen to the teacher's instructions carefully and follow the guidelines.
 Ask questions in the class by raising hand and avoid creating a disturbance.
 To be able to submit all assignments on time and get your sketch logbooks checked.
Lesson contents
Clinical chair side question: Students will be asked if they know what is the function of Cervical & Brachial
Plexus
Outline:
 Activity 1 The facilitator will explain the student's Cervical & Brachial Plexus
 Activity 2 The facilitator will ask the students to make a labeled diagram of the Cervical & Brachial Plexus
 Activity 3 The facilitator will ask the students a few Multiple Choice Questions related to it with flashcards.
Recommendations
 Students assessment: MCQs, Flashcards, Diagrams labeling.
 Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell Clinical Anatomy,
Netter’s Atlas, BD Chaurasia’s Human anatomy, Internet sources links.
Cervical Plexus
 A nerve plexus is a network of
interwoven nerves.
 Cervical plexus provides nerves to:
 Head.
 Neck
 Shoulder.
 Supply: skin, muscles of neck & thoraco-
abdominal diaphragm.
 It is a plexus of loops.
 Formed from the anterior rami of
the first four cervical nerves(C1-
C4).
 Lies beneath prevertebral fascia
(related to Internal Jugular Vein
within Carotid Sheath) on scalenus
medius, levator scapulae & under
cover of sternocleidomastoid.
Formation of Cervical Plexus
 Each formative ramus
divides into upper and
lower branches, except the
first cervical.
 C1 joins with the upper
branch of C2.
U= Upper Branch
L= Lower Branch
Branches Of Cervical Plexus
SUPERFICIAL BRANCHES: 4 cutaneous branches:
 Provides cutaneous innervation to head, neck, and
shoulder area.
 3 ascending branches and 1 descending branch.
 Arise from near the middle of posterior border of
sternocleidomastoid.
 Ascending Branches:-
 Lesser Occipital Nerve(C2)
 Greater Auricular Nerve(C2 & C3)
 Transverse Cutaneous Nerve(C2 & C3)
 Descending Branch:-
 Supraclavicular Nerve(C3 & C4)
sa- spinal accessory, lo- lesser
occipital, ga- greater auricular,
tc- transverse cutaneous,
sc- supraclavicular,
SCM- Sternocleidomastoid
Image showing dermatomes of cutaneous branches of
cervical plexus
Branches of Cervical Plexus
DEEP BRANCHES: Muscular branches.
 Divide into medial and lateral series.
Medial Series:-
 Nerve to Rectus capitis lateralis (C1)
 Nerve to Rectus capitis anterior (C1,C2)
 Nerve to Longus capitis (C1-C4)
 Nerve to Longus colli (C2-C4)
 Inferior root of ansa cervicalis (C2, C3)
 Phrenic nerve (C3, C4, C5)
Deep Branches of Cervical Plexus
Lateral Series:- Nerve to
 Sternocleidomastoid ( C2 )
 Prevertebral Muscles (C2,C3)
 Trapezius ( C3 & C4 )
 Levator scapulae ( C3 & C4 )
 Scalenus medius ( C3 & C4 )
 Scalenus anterior (C4)
Communicating Branches of Cervical Plexus
 With Superior Cervical
sympathetic Ganglion:
 All formative rami of cervical plexus
receives grey rami communicans
from superior cervical sympathetic
ganglion.
Communicating Branches of Cervical Plexus
With Hypoglossal Nerve:
 Banch from loop between C1 &C2 joins
hypoglossal nerve.
 After a short course with the hypoglossal nerve,
leaves that nerve as:-
1. Meningeal branch.
2. Superior root of ansa cervicalis (descends
hypoglossi).
3. Nerve to Thyrohyoid (C1)
4. Nerve to Geniohyoid (C1)
Phrenic Nerve ( C3,C4 &C5 )
 Arise from C3,C4 &C5
 Descends through neck and thorax to
supply the diaphragm.
 It lies on scalenus anterior muscle and
enters thorax between subclavian
artery and subclavian vein (behind
beginning of brachiocephalic vein)
 Only motor nerve to diaphragm.
Scalenus
Anterior
GLAST
1. Greater Auricular Nerve
2. Lesser Occipital Nerve
3. Accessory Nerve
4. Supra-Clavicular Nerve
5. Transverse Cervical Nerve
Clinical Relevance
Phrenic Nerve Injury & Paralysis of Diaphragm
 Phrenic Nerve supply corresponding half of diaphragm
 Can be injured by penetrating wound in neck, &
Paralyzed half of diaphragm relaxes and is pushed up
into the thorax by positive abdominal pressure leading to
collapsing of lower lobe of lung on that side.
 About 1/3rd of persons have an accessory phrenic nerve
 Root of C5 nerve may be incorporated in nerve to
subclavius & may join main phrenic nerve trunk in thorax
Brachial Plexus
Brachial Plexus
 Brachial Plexus are complicated
plexus of nerves present at root of
neck to enter the upper limb
 This allows the nerve fibers derived
from different segments of spinal
cord to be arranged & distributed
efficiently in different nerve trunks
to various parts of upper limb
Location & Formation
 Brachial Plexus is present in lower part
of posterior triangle of neck & Axilla
 It is formed by union of anterior rami of
5th, 6th, 7th and 8th cervical & 1st thoracic
spinal nerves
Formation
Plexus can be divided into:
 Roots
 Trunks
 Divisions
 Cords
 Branches
Remember to
drink cold Beer
Roots & Trunk
 Roots enter Posterior Triangle between scalenus anterior & medius muscles.
 Together with subclavian artery covered by axillary sheath
 The roots of C5 & 6 unite to form upper trunk
 The root of C7 continues as the middle trunk
 The roots of C8 & T1 unite to form lower trunk (lie behind 3rd part of sub-
clavian artery)
Divisions
Each trunk divides into:
 Anterior divisions
 Posterior divisions
Cords
 The anterior divisions of the upper and middle trunks unite to
form the lateral cord
 The anterior division of the lower trunk continues as the
medial cord
 The posterior divisions of all three trunks join to form the
posterior cord
Axillary Sheath
 The cords become arranged around
the axillary artery in the axilla
 Brachial Plexus, the axillary artery
and vein are enclosed by a sheath of
fascia called AXILLARY SHEATH
Relation of Cords
 All three cords of brachial plexus lie above & lateral
to first part of axillary artery
 Medial cord crosses behind artery to reach medial
side of second part of axillary artery
 Posterior cord lies behind second part of artery
 Lateral cord lies on lateral side of second part of
artery
Branches
 The branches of the different parts of brachial plexus are:
Roots:
 Dorsal scapular nerve (C5)
 Long thoracic nerve (C5, 6 and 7)
Upper Trunk:
 Nerve to subclavius (C5 and 6)
 Suprascapular nerve (supplies
the supraspinatus and
infraspinatus muscles)
Lateral Cord:
 Lateral pectoral nerve
 Musculocutaneous nerve
 Lateral root of median nerve
Medial Cord:
 Medial pectoral nerve
 Medial cutaneous nerve of arm and
medial cutaneous nerve of forearm
 Ulnar nerve
 Medial root of median nerve
Posterior Cord:
 Upper and lower subscapular nerves
 Thoracodorsal nerve
 Axillary nerve
 Radial nerve
Branches in Axilla
 Nerve to Subclavius:
 Supplies: subclavian muscle
 May give contribution (C5) to
phrenic nerve
Long Thoracic Nerve:
 Arises from the root
 Enters the axilla by passing down over
the lateral border of the 1st rib behind the
axillary vessels and brachial plexus
 Supplies the serratus anterior muscle
Lateral Pectoral Nerve
 Arises from the lateral cord
 Supplies the pectoralis major muscle
Musculocutaneous Nerve:
 Arises from the lateral cord
 Supplies the coracobrachialis muscle
 Leaves the axilla by piercing this muscle
Lateral Root of the Median Nerve:
 Is a direct continuation of the lateral
cord
 Is joined by the medial root to form
the median nerve trunk
 Gives no branch in the axilla
Medial Pectoral Nerve:
 Arises from the medial cord
 Supplies and pierces the pectoralis
minor Muscle
 Supplies the pectoralis major muscle
Medial Cutaneous Nerve of the Arm
 Arises from the medial cord
 Is joined by intercostobrachial
nerve
 Supplies the skin on the medial
side of the arm
Medial Cutaneous Nerve of the
Forearm:
 Arises from the medial cord
 Descends in front of the axillary artery
Ulnar Nerve:
 Arises from the medial cord
 Descends between axillary artery and
vein
 Gives no branches in the axilla
Medial Root of the Median Nerve:
 Arises from the medial cord
 Crosses in front of the 3rd part of axillary
artery
 Joins the lateral root of the median nerve
Upper and Lower Subscapular Nerve:
 Arise from the posterior cord
 Supply the upper and lower part of the
suscapularis muscle and teres muscle
(only lower subscapular nerve)
Thoracodorsal Nerve:
 Arises from the posterior cord
 Runs downward to supply the
latissimus dorsi muscle
Axillary Nerve:
 Is one of the terminal branches of
posterior cord
 Gives branch to the shoulder joint
 Divides into anterior and posterior
branches
Radial Nerve:
 Largest branch of brachial plexus
 Lies behind the axillary artery
 Supplies the long and medial heads of
Triceps muscle and the posterior
cutaneous nerve of the arm
Clinical Relevance
Brachial Plexus Injuries
Erb’s Paralysis
 Site of injury: upper trunk ; Erb’s Point
 6 nerves meet
1. C5 Root
2. C6 Root
3. Suprascapular nerve
4. Nerve to subclavius
5. Dorsal division
6. Ventral division
Erb’s Paralysis: The Cause
 Undue separation of head &
shoulder
 Birth injury
Fall on shoulder
During anesthesia
 Roots involved: C5, C6
 Muscle paralysed: Biceps, deltoid,
brachialis and brachioradialis,
supraspinatus, infraspinatus and
supinator
Erb’s Paralysis: Deformity- position of
limb policeman’s tip or porter’s tip
hand
 Arms: hangs by side, adducted & medially rotated
 Forearm: extended & pronated
 Disability: abduction & lateral rotation of arm shoulder
 Flexion and supination of forearm
 Loss of biceps & supinator jerks
 Loss of sensations over the lower part of deltoid
Klumpke’s paralysis
 Site of injury: lower trunk of brachial plexus
 Cause of injury: undue abduction of arm as in clutching
something after a fall from a height or birth injury
 Nerve roots involved: T1 and partly C8
 Muscle Paralysed: intrinsic muscles of hand
 Ulnar flexors of wrist and fingers
Klumpke’s paralysis
 Disability: ( Motor loss) paralysis of ulnar flexors of
fingers
 loss of sensations :along ulnar border of forearm and
hand
 Horner’s Syndrome: Ptosis, miosis, anhydrosis,
enophthalmos and loss of ciliospinal reflex due to injury
to sympathetic fibres to head and neck in T1
 Deformity: Claw hand
 hyperextension at metacarpo-phlangeal joints
 flexion at inter - phalangeal joints
Injury to nerve to Serratus Anterior
Nerve of Bell
 Cause: sudden pressure on shoulder from above
carrying heavy load on shoulders
 Deformity: winging of scapula
 Disability: loss of pushing and punching
 Loss of overhead abduction at shoulder
TEST?
Identify?
Thank You

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Cervical & Brachial Plexus By Dr. RIG.pptx

  • 1. Cervical & Brachial Plexus Dr. Rabia Inam Gandapore Assistant Professor Head of Department Anatomy (Dentistry-BKCD) B.D.S (SBDC), M.Phil. Anatomy (KMU), Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE (KMU),CHR (KMU), Dip. Arts (Florence, Italy)
  • 2. Teaching Methodology  LGF (Long Group Format)  SGF (Short Group Format)  LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams)  SGD (Short Group)  SDL (Self-Directed Learning)  DSL (Directed-Self Learning)  PBL (Problem- Based Learning)  Online Teaching Method  Role Play  Demonstrations  Laboratory  Museum  Library (Computed Assisted Learning or E-Learning)  Assignments  Video tutorial method
  • 3. Goal/Aim (main objective) To help/facilitate/augment the students about the:  Enlist branches of cervical plexus  Describe the formation of brachial plexus.  Enlist the branches of brachial plexus.
  • 4. Specific Learning Objectives (cognitive) At the end of the lecture the student will able to:  Enlist branches of cervical plexus  Describe the formation of brachial plexus.  Enlist the branches of brachial plexus.
  • 5. Psychomotor Objective: (Guided response)  A student to draw labelled diagram of the Cervical and Brachial Plexus
  • 6. Affective domain  To be able to display a good code of conduct and moral values in the class.  To cooperate with the teacher and in groups with the colleagues.  To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on time in the class.  To be able to perform well in the class under the guidance and supervision of the teacher.  Study the topic before entering the class.  Discuss among colleagues the topic under discussion in SGDs.  Participate in group activities and museum classes and follow the rules.  Volunteer to participate in psychomotor activities.  Listen to the teacher's instructions carefully and follow the guidelines.  Ask questions in the class by raising hand and avoid creating a disturbance.  To be able to submit all assignments on time and get your sketch logbooks checked.
  • 7. Lesson contents Clinical chair side question: Students will be asked if they know what is the function of Cervical & Brachial Plexus Outline:  Activity 1 The facilitator will explain the student's Cervical & Brachial Plexus  Activity 2 The facilitator will ask the students to make a labeled diagram of the Cervical & Brachial Plexus  Activity 3 The facilitator will ask the students a few Multiple Choice Questions related to it with flashcards.
  • 8. Recommendations  Students assessment: MCQs, Flashcards, Diagrams labeling.  Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell Clinical Anatomy, Netter’s Atlas, BD Chaurasia’s Human anatomy, Internet sources links.
  • 9. Cervical Plexus  A nerve plexus is a network of interwoven nerves.  Cervical plexus provides nerves to:  Head.  Neck  Shoulder.  Supply: skin, muscles of neck & thoraco- abdominal diaphragm.
  • 10.  It is a plexus of loops.  Formed from the anterior rami of the first four cervical nerves(C1- C4).  Lies beneath prevertebral fascia (related to Internal Jugular Vein within Carotid Sheath) on scalenus medius, levator scapulae & under cover of sternocleidomastoid.
  • 11.
  • 12. Formation of Cervical Plexus  Each formative ramus divides into upper and lower branches, except the first cervical.  C1 joins with the upper branch of C2. U= Upper Branch L= Lower Branch
  • 13. Branches Of Cervical Plexus SUPERFICIAL BRANCHES: 4 cutaneous branches:  Provides cutaneous innervation to head, neck, and shoulder area.  3 ascending branches and 1 descending branch.  Arise from near the middle of posterior border of sternocleidomastoid.  Ascending Branches:-  Lesser Occipital Nerve(C2)  Greater Auricular Nerve(C2 & C3)  Transverse Cutaneous Nerve(C2 & C3)  Descending Branch:-  Supraclavicular Nerve(C3 & C4) sa- spinal accessory, lo- lesser occipital, ga- greater auricular, tc- transverse cutaneous, sc- supraclavicular, SCM- Sternocleidomastoid
  • 14. Image showing dermatomes of cutaneous branches of cervical plexus
  • 15. Branches of Cervical Plexus DEEP BRANCHES: Muscular branches.  Divide into medial and lateral series. Medial Series:-  Nerve to Rectus capitis lateralis (C1)  Nerve to Rectus capitis anterior (C1,C2)  Nerve to Longus capitis (C1-C4)  Nerve to Longus colli (C2-C4)  Inferior root of ansa cervicalis (C2, C3)  Phrenic nerve (C3, C4, C5)
  • 16.
  • 17.
  • 18.
  • 19. Deep Branches of Cervical Plexus Lateral Series:- Nerve to  Sternocleidomastoid ( C2 )  Prevertebral Muscles (C2,C3)  Trapezius ( C3 & C4 )  Levator scapulae ( C3 & C4 )  Scalenus medius ( C3 & C4 )  Scalenus anterior (C4)
  • 20. Communicating Branches of Cervical Plexus  With Superior Cervical sympathetic Ganglion:  All formative rami of cervical plexus receives grey rami communicans from superior cervical sympathetic ganglion.
  • 21.
  • 22. Communicating Branches of Cervical Plexus With Hypoglossal Nerve:  Banch from loop between C1 &C2 joins hypoglossal nerve.  After a short course with the hypoglossal nerve, leaves that nerve as:- 1. Meningeal branch. 2. Superior root of ansa cervicalis (descends hypoglossi). 3. Nerve to Thyrohyoid (C1) 4. Nerve to Geniohyoid (C1)
  • 23. Phrenic Nerve ( C3,C4 &C5 )  Arise from C3,C4 &C5  Descends through neck and thorax to supply the diaphragm.  It lies on scalenus anterior muscle and enters thorax between subclavian artery and subclavian vein (behind beginning of brachiocephalic vein)  Only motor nerve to diaphragm. Scalenus Anterior
  • 24. GLAST 1. Greater Auricular Nerve 2. Lesser Occipital Nerve 3. Accessory Nerve 4. Supra-Clavicular Nerve 5. Transverse Cervical Nerve
  • 26. Phrenic Nerve Injury & Paralysis of Diaphragm  Phrenic Nerve supply corresponding half of diaphragm  Can be injured by penetrating wound in neck, & Paralyzed half of diaphragm relaxes and is pushed up into the thorax by positive abdominal pressure leading to collapsing of lower lobe of lung on that side.  About 1/3rd of persons have an accessory phrenic nerve  Root of C5 nerve may be incorporated in nerve to subclavius & may join main phrenic nerve trunk in thorax
  • 28. Brachial Plexus  Brachial Plexus are complicated plexus of nerves present at root of neck to enter the upper limb  This allows the nerve fibers derived from different segments of spinal cord to be arranged & distributed efficiently in different nerve trunks to various parts of upper limb
  • 29.
  • 30. Location & Formation  Brachial Plexus is present in lower part of posterior triangle of neck & Axilla  It is formed by union of anterior rami of 5th, 6th, 7th and 8th cervical & 1st thoracic spinal nerves
  • 31.
  • 32. Formation Plexus can be divided into:  Roots  Trunks  Divisions  Cords  Branches Remember to drink cold Beer
  • 33. Roots & Trunk  Roots enter Posterior Triangle between scalenus anterior & medius muscles.  Together with subclavian artery covered by axillary sheath  The roots of C5 & 6 unite to form upper trunk  The root of C7 continues as the middle trunk  The roots of C8 & T1 unite to form lower trunk (lie behind 3rd part of sub- clavian artery)
  • 34.
  • 35. Divisions Each trunk divides into:  Anterior divisions  Posterior divisions
  • 36. Cords  The anterior divisions of the upper and middle trunks unite to form the lateral cord  The anterior division of the lower trunk continues as the medial cord  The posterior divisions of all three trunks join to form the posterior cord
  • 37.
  • 38. Axillary Sheath  The cords become arranged around the axillary artery in the axilla  Brachial Plexus, the axillary artery and vein are enclosed by a sheath of fascia called AXILLARY SHEATH
  • 39. Relation of Cords  All three cords of brachial plexus lie above & lateral to first part of axillary artery  Medial cord crosses behind artery to reach medial side of second part of axillary artery  Posterior cord lies behind second part of artery  Lateral cord lies on lateral side of second part of artery
  • 40.
  • 41. Branches  The branches of the different parts of brachial plexus are:
  • 42. Roots:  Dorsal scapular nerve (C5)  Long thoracic nerve (C5, 6 and 7)
  • 43. Upper Trunk:  Nerve to subclavius (C5 and 6)  Suprascapular nerve (supplies the supraspinatus and infraspinatus muscles)
  • 44. Lateral Cord:  Lateral pectoral nerve  Musculocutaneous nerve  Lateral root of median nerve
  • 45. Medial Cord:  Medial pectoral nerve  Medial cutaneous nerve of arm and medial cutaneous nerve of forearm  Ulnar nerve  Medial root of median nerve
  • 46. Posterior Cord:  Upper and lower subscapular nerves  Thoracodorsal nerve  Axillary nerve  Radial nerve
  • 47.
  • 48. Branches in Axilla  Nerve to Subclavius:  Supplies: subclavian muscle  May give contribution (C5) to phrenic nerve
  • 49. Long Thoracic Nerve:  Arises from the root  Enters the axilla by passing down over the lateral border of the 1st rib behind the axillary vessels and brachial plexus  Supplies the serratus anterior muscle
  • 50. Lateral Pectoral Nerve  Arises from the lateral cord  Supplies the pectoralis major muscle
  • 51. Musculocutaneous Nerve:  Arises from the lateral cord  Supplies the coracobrachialis muscle  Leaves the axilla by piercing this muscle
  • 52.
  • 53. Lateral Root of the Median Nerve:  Is a direct continuation of the lateral cord  Is joined by the medial root to form the median nerve trunk  Gives no branch in the axilla
  • 54.
  • 55. Medial Pectoral Nerve:  Arises from the medial cord  Supplies and pierces the pectoralis minor Muscle  Supplies the pectoralis major muscle
  • 56. Medial Cutaneous Nerve of the Arm  Arises from the medial cord  Is joined by intercostobrachial nerve  Supplies the skin on the medial side of the arm
  • 57. Medial Cutaneous Nerve of the Forearm:  Arises from the medial cord  Descends in front of the axillary artery
  • 58. Ulnar Nerve:  Arises from the medial cord  Descends between axillary artery and vein  Gives no branches in the axilla
  • 59. Medial Root of the Median Nerve:  Arises from the medial cord  Crosses in front of the 3rd part of axillary artery  Joins the lateral root of the median nerve
  • 60. Upper and Lower Subscapular Nerve:  Arise from the posterior cord  Supply the upper and lower part of the suscapularis muscle and teres muscle (only lower subscapular nerve)
  • 61. Thoracodorsal Nerve:  Arises from the posterior cord  Runs downward to supply the latissimus dorsi muscle
  • 62. Axillary Nerve:  Is one of the terminal branches of posterior cord  Gives branch to the shoulder joint  Divides into anterior and posterior branches
  • 63. Radial Nerve:  Largest branch of brachial plexus  Lies behind the axillary artery  Supplies the long and medial heads of Triceps muscle and the posterior cutaneous nerve of the arm
  • 66. Erb’s Paralysis  Site of injury: upper trunk ; Erb’s Point  6 nerves meet 1. C5 Root 2. C6 Root 3. Suprascapular nerve 4. Nerve to subclavius 5. Dorsal division 6. Ventral division
  • 67. Erb’s Paralysis: The Cause  Undue separation of head & shoulder  Birth injury Fall on shoulder During anesthesia  Roots involved: C5, C6  Muscle paralysed: Biceps, deltoid, brachialis and brachioradialis, supraspinatus, infraspinatus and supinator
  • 68. Erb’s Paralysis: Deformity- position of limb policeman’s tip or porter’s tip hand  Arms: hangs by side, adducted & medially rotated  Forearm: extended & pronated  Disability: abduction & lateral rotation of arm shoulder  Flexion and supination of forearm  Loss of biceps & supinator jerks  Loss of sensations over the lower part of deltoid
  • 69. Klumpke’s paralysis  Site of injury: lower trunk of brachial plexus  Cause of injury: undue abduction of arm as in clutching something after a fall from a height or birth injury  Nerve roots involved: T1 and partly C8  Muscle Paralysed: intrinsic muscles of hand  Ulnar flexors of wrist and fingers
  • 70. Klumpke’s paralysis  Disability: ( Motor loss) paralysis of ulnar flexors of fingers  loss of sensations :along ulnar border of forearm and hand  Horner’s Syndrome: Ptosis, miosis, anhydrosis, enophthalmos and loss of ciliospinal reflex due to injury to sympathetic fibres to head and neck in T1  Deformity: Claw hand  hyperextension at metacarpo-phlangeal joints  flexion at inter - phalangeal joints
  • 71. Injury to nerve to Serratus Anterior Nerve of Bell  Cause: sudden pressure on shoulder from above carrying heavy load on shoulders  Deformity: winging of scapula  Disability: loss of pushing and punching  Loss of overhead abduction at shoulder
  • 72. TEST?