Nerves of the upper limbs

1. Nerves of the upper limbs Dr. M Koruji, PhD, Anatomical Sciences Department, TUMS

2. Brachial plexus

3. Roots • Anterior rami of C5 to C8, and most of T1 • Gray ramicommunicantes from the sympathetic trunk: • postganglionic sympathetic fibers

4. Trunks • The superior trunk : • C5 and C6 roots; • The middle trunk : • C7 root; • The inferior trunk • C8 and T1 roots.

5. Divisions & Cords • Divisions • Anterior and a posterior division • The three anterior divisions : anterior compartments of the arm and forearm; • The three posterior divisions: the posterior compartments. • Cords • Lateral cord • Medial cord • Posterior cord

6. Dorsal scapular • Originates from the C5 root • Pierce the middle scalene muscle • Innervates the rhomboid major and minor muscles

7. Long thoracic • Originates from C5 to C7; • Down the axilla to supply the serratus anterior muscle • Lies on the superficial aspect of muscle

8. Suprascapular nerve Nerve to subclavius muscle

9. Cords • Lateral cord(C5-C7) • Lateral pectoral, • Musculocutaneous nerve, • Lateral root of median • Medial cord(C8-T1) • Medial pectoral, • Medial cutaneous of forearm, • Medial cutaneous of arm, • Medial root of Median nerve • Ulnar nerve • Posterior cord(C5-T1) • Upper subscapular, Thoracodorsal, • Lower subscapular • Axillary nerve • Radial nerve

10. Muscolocutaneous nerve • Motor innervationto all muscles in the anterior compartment of the arm; and • Sensory innervationto skin on the lateral surface of the forearm.

11. Muscolocutaneous nerve

12. Median nerve

13. Vasomotor to brachial artery Median nerve

14. Medial cord • The medial pectoral nerve major muscle. • The medial cutaneous nerve of arm (medial brachial cutaneous nerve) • The medial cutaneous nerve of forearm (medial antebrachial cutaneous nerve) • The medial root of median nerve • The ulnar nerve

15. Ulnar nerve

16. Posterior cord • The superior subscapular nerve; • The thoracodorsal nerve; • The inferior subscapular nerve;, • The axillary nerve; • The radial nerve

17. Axillary nerve • Deltoid • Teres minor • Upper lateral cutaneous nerve of the arm

18. Axillarynerve

20. Radial nerve • All muscles in the posterior compartments of the arm and forearm; • The skin on the posterior aspect of the arm and forearm, the lower lateral surface of the arm, • The dorsal lateral surface of the hand.

21. Radial nerve

22. Radial nerve In Axilla • Med head, • post cut arm, • long head

23. Radial nerve In Arm • Lat. head • Med. head • Lower lat. Cut. arm • Post. Cut. forearm

25. Radial nerve injury in the arm • Wrist drop (due to denervation of the extensor muscles) • sensory changes over the dorsum of the hand Wrist drop

26. Upper limb 1- Shoulder Girdle 2- Arm (Brachium) 3- Forearm (Anti brachium) 4- Hand 1- Hard Tissue The upper limb skeleton (32) 2-Soft tissue Muscles Vessels Nerves

27. Nerves of forearm • Musculocutaneous nerve (lat.Cutaneous nerve of forearm) • Median nerve • Radial nerve • Ulnar nerve

28. Muscolocutaneous nerve

29. Median nerve

30. Nerves of the Anterior Forearm

32. musclucutaneous Median nerve

33. Anterior interosseous nerve

35. Ape hand

36. Ulnar nerve • Muscular branches • Two small cutaneous branches • Palmar branch supply skin on the medial side of the palm; • The larger dorsal branch • Posterior surfaces of the medial one and one-half digits. Ulnar nerve

37. 1

38. Ulnar nerve

41. Ulnar nerve injury • Clawed-hand • Metacarpophalangeal joints are hyperextended and the interphalangeal joints are flexed • Damage to the ulnar nerve at the wrist : dorsal branch

42. Radial nerve

43. Superficial terminal branch

44. Deep terminal branch(post. interosseous

45. wrist drop

46. Brachialis-Joint Radial nerve

47. Axi Axi T2 R Cutaneous nerves of forearm and hand

48. Nerves of the Hand

49. Cutaneous Nerves and Superficial Veins of the Hand, Posterior View