The document summarizes the anatomy and clinical presentations of injuries to the radial, median, and ulnar nerves. It describes the formation and branches of the brachial plexus. The radial nerve arises from the posterior cord and innervates the triceps and muscles of the posterior forearm. Median nerve injury can cause pointing of the index finger. Ulnar nerve injury results in a claw hand deformity due to paralysis of the intrinsic hand muscles.

1. Upper limb nerve
examination
DR ADITYA APTE
VPMC & RC NASHIK

2. Brachial plexus
1.Formed by the ventral ramii of cervical spinal nerves
c5 to c8 and the thoracic spinal nerve T1
2.Prefix- includes the ramii of C4
3.Postfix- includes the ramii of T2
4.Consists of ROOTS, TRUNKS , DIVISIONS , CORDS and
BRANCHES
5.Responsible for sensory and motor innervation
of entire limb

3.  ROOTS- consists of ventral ramii of spinal nerves C5 to T1
 TRUNKS- roots c5 and c6 join to form the upper trunk
root c7 forms the middle trunk
roots c8 and T1 forms the lower trunk
CORDS- lateral cord- ventral division of upper and
middle trunk
medial cord-ventral division of lower trunk
posterior cord- dorsal division of all 3 trunks.

4. Branches of brachial plexus

5. Radial nerve
 Arises from posterior cord of brachial plexus
 Root value- c5 to T1
 Enters the arm behind the axillary artery in the post. Compartment of arm
 Enters the radial groove to emerge on the lateral aspect of arm in the
anterior compartment
 Reaches the distal part of humerus and passes anterior to the lateral
epicondyle to enter forearm

6.  Branches in arm-
 Before entering spiral groove- motor br. To long and medial head of
triceps and the posterior cutaneous nerve of arm
 In the spiral groove- motor br. To lateral and medial head of triceps and
the post cutaneous nerve of forearm and the lower lateral cut. Nerve of
arm
 Between the spiral groove and elbow-brachioradialis and ECRL
 After crossing elbow before piercing supinator-supinator and ECRB
 After piercing the supinator-continues as the post interroseous nerve and
supplies the post. Compartment of forearm
 ECRL- last muscle supplied by radial nerve

17. Radial nerve injury

19. Compression syndromes

24. Median nerve
 Also called labourer’s nerve
 derived from both the medial and lateral cords of
the brachial plexus
 Lateral root of median nerve- c6 c7
 Medial root of median nerve- c8 t1

26.  In the arm proximally the median nerve is lateral to the axillary artery
 Midway through the arm it crosses the artery from lateral to medial
anteriorly and lies medial to the brachial artery in the cubital fossa
 Gives an articular branch to the elbow and a branch to pronater teres just
before the joint
 In the cubital fossa gives branches to palmaris longus, FCR and FDS

27.  Enters the forearm between the two heads of pronater teres and supplies
the deep muscles of flexor compartment as the Ant. Interroseous nerve
 Gives no branches in the ARM
 In the hand- supplies the thenar muscles except adductor policis and the
lateral 2 lumbricals
 Sensory distribution-lateral two third of palm
lateral three and half fingers on palmar side
distal phalanx of lat. Three and half fingers on dorsal
side.

39. Aetiology of median nerve injury
 At the elbow- supracondylar humerus fractures; elbow dislocations
 At the wrist- sharp cuts ; lunate dislocation ; carpel tunnel syndrome
 Features-
 Pointing index-paralysis of FDS and FDP of index finger leads to failure of
its flexion
 Pen test- APB paralysis
 Ape thumb-thumb lies in the same plane as rest of the fingers in adducted
and laterally rotated position( due to overactivity of adductor policis)
 Wasting of thenar muscles

40. Ulnar nerve
 Originates from the medial cord ; c8 T1
 Descend medial to the brachial artery and enters the posterior
compartment of the arm
 Not a content of the cubital fossa as it passes behind the
medial epicondyle at elbow.
 Enters the anterior compartment of forearm between the two
heads of FCU.

41.  Does not give branch in arm
 In the forearm- FCU and medial third of FDP
 In the hand- superficial branch- hypothenar muscles
 deep branch- adductor pollicis, interrossie,
medial two lumbricals

52.  Called the muscians nerve as it controls the finer movements
of hand
 Claw hand- hyperextension at MCP and flexion at IP joints. (
due to paralysis of intrinsic musces)
 Ulnar paradox- clawing seen in low ulnar palsies and not in
high palsy
 In high palsy there is paralysis of FDP hence flexion at IP joint
does not occur.

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