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BRACHIAL PLEXUS

BRACHIAL PLEXUS. BRACHILAL PLEXUS. The brachial plexus is a somatic nerve plexus formed by intercommunications among the ventral rami of the lower four cervical nerves ( C 5 - C 8) and the first thoracic nerve (T 1).

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BRACHIAL PLEXUS

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  1. BRACHIAL PLEXUS

  2. BRACHILAL PLEXUS • The brachial plexus is a somatic nerve plexus formed by intercommunications among the ventral rami of the lower four cervical nerves ( C 5 - C 8) and the first thoracic nerve (T 1). • The plexus is responsible for the motor innervation to all of the muscles of the upper limb with the exception of the trapezius and levator scapula.) • sensory innervation of the upper limb

  3. SPINAL NERVES • 31 pairs of spinal nerves are attached to the spinal cord • 8 Cervical • 12 Thoracic • 5 lumbar • 5 sacral • 1 coccygeal

  4. SPINAL NERVES Dorsal branch Spinal nerve Ventral branch

  5. BRACHIAL PLEXUS • It is a network of nerves which supplies upper limb. • Formed - ventral rami (branches) of C5 – C8 & T1 spinal nerves. • Origin - neck, passes laterally & enters the axilla.

  6. BRACHIAL PLEXUS ROOTS TRUNKS DIVISIONS CORDS BRANCHES

  7. PARTS • SUPRACLAVICULAR PART • Roots , trunks and divisions • INFRACLAVICULAR PART • Cords and branches

  8. Relations of Brachial plexus

  9. FORMATION . Roots Union of ventral rami of C5,C6,C7,C8&T1 C5 receives contribution fromC4. T1receives contribution from T2 PREFIXED: C4 contribution is large and T1 root is small POSTFIXED:T2 contribution is large and C5 root will be small

  10. Roots Combine Forming Trunks Which Then Split Into Divisions C5 Anterior Division Upper Trunk C6 Posterior Division Anterior Division C7 Middle Trunk Posterior Division C8 Anterior Division Lower Trunk T1 Posterior Division

  11. Divisions Form Cords • Anterior Lateral Cord • Posterior • Anterior Medial Cord • Posterior • AnteriorPosterior Cord • Posterior Upper Middle Lower

  12. TRUNKS • UPPER TRUNK • Union of C5 and C6 • MIDDLE TRUNK • Only C7 • LOWER TRUNK • Union of C8 and T1

  13. CORDS DIVISIONS TRUNKS ROOTS C5 LATERAL UPPER C6 POSTERIOR MIDDLE C7 C8 LOWER MEDIAL T1

  14. DIVISIONS • Each trunk divides into an anteriorand posteriordivisions.

  15. CORDS • LATERAL CORD: • Union of anterior divisions of upper and middle trunks • MEDIAL CORD: • Anterior division of lower trunk • POSTERIOR CORD: • Union of Posterior divisions of upper,middle and lower trunks

  16. Brachial Plexus 18 Cleyson Mupfiga HUB117 2011

  17. BRANCHES • FROM ROOTS • 1.Long thoracic nerve(C5,C6&C7) • 2.Dorsal scapular nerve(C5) • 3.Branch to phrenic nerve(C5) • FROM TRUNK • (ONLY FROM THE UPPER TRUNK- ERB`S POINT) • 1.Suprascapular nerve(C5,6) • 2.Nerve to subclavius(C5,6)

  18. MUSCULAR SUPPLY ROOTS • Dorsal scapular nerve-Rhomboides major and minor • Long thoracic nerve-Serratus anterior • Phrenic nerve-Diaphragm

  19. MUSCULAR SUPPLY TRUNK • Suprascapular nerve - supraspinatus and infraspinatus • Nerve to subclavius-subclavius

  20. FROM CORDS • LATERAL CORD: • 1.Lateral pectoral nerve(C5,6,7) • 2.Musculocutaneous nerve(C5,6,7) • 3.Lateral root of median nerve(C5,6,7)

  21. FROM CORDS • MEDIAL CORD: • 1.Medial pectoral nerve [C8, T1] • 2.Medial cutaneous nerve of arm [C8, T1] • 3.Medial cutaneous nerve of forearm [C8, T1] • 4.Medial root of median nerve [C8, T1] • 5.Ulnar nerve [C7, C8, T1]

  22. FROMCORDS • POSTERIOR CORD: • 1. Upper subscapular nerve (C5,6) • 2. Thoracodorsal nerve (C6,7,8) • 3. Lower subscapular nerve (C5,6) • 4. Axillary nerve (C5,6) • 5. Radial nerve (C5, 6, 7, 8 &T1)

  23. APPLIED ANATOMY • Trauma • compression • Wounds in the neck or axilla • Malignancy of breast

  24. BRACHIAL PLEXUS INJURIES • ERB`S PARALYSIS • Site of injury: Erb`s point • Injury to the upper trunk • Cause of injury: • Undue separation of the head and shoulder may be due to: • 1.Birth injury (forceps delivery) • 2.Fall on the shoulder • 3.During anaesthesia

  25. ERB`S PARALYSIS • Nerve roots involved:C5&C6 • Muscles paralysed: Biceps brachii,deltoid,brachialis,brachioradialis • Deformity(Position of the limb): • Arm: hangs by the side;it is adducted and medially rotated. • Forearm:extended and pronated • The deformity is called POLICEMAN`S TIP HAND OR PORTER`S TIP HAND

  26. KLUMPKE`S PARALYSIS • Site of injury:Lower trunk • Cause of injury:Undue abduction of arm(fall from a height) or birth injury • Nerve roots involved:C8,T1 • Muscles paralysed:intrinsic muscles of hand, • ulnar flexors of wrist and fingers • Deformity:Claw hand

  27. KLUMPKE’S PARALYSIS

  28. CLAW HAND

  29. INJURY TO LONG THORACIC NERVE • Cause:Sudden pressure on the shoulder from above,carrying heavy loads on the shoulder. • Paralysis of serratus anterior • Deformity:Winging of scapula(excessive prominence of medial border of the scapula) • Disability: • Loss of pushing and punching actions • Arm cannot be raised beyond 90 degrees.

  30. Winged scapular deformity • Caused by injury to long thoracic nerve of Bell • (C5, 6 and 7)

  31. THANK YOU

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