Brachial Plexus D.Rania Gabr D.Sama-ul-Haque D.Elsherbiny

Objectives Describe the brachial plexus Make a list of contributing spinal nerves. Discuss the general arrangement of this plexus. Locate the plexus in the axilla and note important relations to blood vessels. Make a list of the terminal main branches of brachial plexus.

Location of Brachial plexus

Brachial Plexus Def: nerve supply of upper limb. Formation: It is formed by the union of the anterior Rami of the C 5th, 6th, 7th & 8th and T1 spinal nerve. Roots…….trunks……division……cords…..branches Site: Roots & Trunks: in the posterior∆ Divisions: behind the clavicle (in cervico-axillary canal). Cords & Branches: in the axilla

N e c k C l a v i c l e A x i l l a R o o t s T r u n k s D i v i s i o n s C o r d s B r a n c h e s C 5 A upper lateral 3 P C 6 C 7 middle posterior 5 C 8 lower 5 T 1 medial

Brachial Plexus Roots : C5,6,7,8 and T1. Trunk: Upper trunk: union of C5.6 Middle trunk: C7. Lower trunk : union of C8 and T1. Division; each trunk divides into anterior and posterior. Cords; Lateral cord: union of anterior division of upper and middle trunk. Medial cord: anterior division of lower trunk. Posterior cord: union of posterior division of upper, middle and lower trunk.

Branches Brachial Plexus (A) From Roots: 1. C5: Nerve to rhomboids (dorsal scapular nerve). 2. C5,6 &7: Long thoracic nerve (B) From Trunks (upper trunk): Nerve to subclavius Suprascapular nerve

(C)Branches from the cords: Lateral Cord (2LM) .Lateral pectoral n .Lateral root to median n .Musculocutaneous n C5 C6 C7 C8 T1 Medial cord (4MU) .Medial pectoral n. .Medial root to median n. .Medial cutaneous n of arm. .Medial cutaneous n of forearm. .Ulnar n. Posterior Cord (ULTRA) .Upper subscapular n .Lower subscapular n .Thoracodorsal n .Radial n .Axillary n

Lateral cord-3 Medial cord-5 Posterior cord-5 Lateral pectoral nerve. Medial pectoral nerve. Axillary nerve. Musculocutaneous nerve. Ulnar nerve. Radial nerve. Median nerve (lateral root). Median nerve (medial root). Upper & lower subscapular nerves. Medial cutaneous nerve of arm & forearm. Thoracodorsal or N. to latissimus dorsi.

Relations of Brachial plexus

Relations of brachial plexus Posterior Posterior cord Lateral cord Axillary artery Medial cord Lateral Medial Axillary vein Anterior

Brachial Plexus Injuries Nerve injury is manifested by: 1. Loss of sensation: in the area of cutaneous distribution. 2. Paralysis of voluntary muscles supplied. 3. Wasting of paralyzed muscles.

Lesions of the upper trunk C5,6 ERB'S paralysis Cause: Birth injury. The most commonly involved nerves:suprascapular nerve, musculocutaneous, and axillary nerve: Muscles atrophy: a. Muscles of shoulder. b. Flexors of elbow. c. Extensors of finger.

Policeman (waiter) tips paralysis a. Adduction of the arm. b. Extension of the elbow. c. Pronation of the forearm. d. Flexion of the fingers.

Falling on Shoulder

Excessive Stretching

Direct Blow

Lesions of the lower trunk (C8,T1) Klumpke paralysis or Palsy Cause: Cervical rib (compression of the lower trunk and subclavian artery). Deformity: Flail (claw) hand. Muscles atrophy: All the intrinsic muscles of the hand.

Baby’s upper limb is pulled excessively during delivery

Claw Hand