Post on 28-Feb-2018
7/25/2019 Brachial Plexus Lecture
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Plexus of nerves thatPlexus of nerves thatinnervates the upperinnervates the upper
limblimbFormation :Formation : Ventral rami of spinalVentral rami of spinal
nerves C5,6,7,8 and T1nerves C5,6,7,8 and T1
Runs down between theRuns down between the!alenus"anterior#medius!alenus"anterior#mediusmus!le in themus!le in the
supra!lavi!ular re$ionsupra!lavi!ular re$ion %ivided into trun&s,%ivided into trun&s,divisions, !ords anddivisions, !ords andbran!hesbran!hes
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Variation in the bra!hial plexusVariation in the bra!hial plexus
Prefixed brachialPrefixed brachial plexus:plexus: with C' root with C' root
Postfixed brachialPostfixed brachial plexusplexus( with T) root( with T) root
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RReall*eall* TTired+ired+ %%rin&rin& CCoffee,offee,
udd*-udd*-
RRootsoots
TTrunksrunks
DDivisionsivisions
CCordsordsBBranchesranches
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C5C5 .nterior %ivision .nterior %ivision
/pper Trun&/pper Trun&
C6C6
Posterior %ivisionPosterior %ivision
.nterior %ivision .nterior %ivision
C7C7 0iddle Trun&0iddle Trun&
Posterior %ivisionPosterior %ivision
C8C8 .nterior %ivision .nterior %ivision
ower Trun&ower Trun&
T1T1 Posterior %ivisionPosterior %ivision
Roots Trun& %ivision
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.nterior .nterior ateral Cordateral Cord
PosteriorPosterior
.nterior .nterior 0edial Cord0edial Cord
Posterior Posterior
.nterior .nterior Posterior CordPosterior Cord
Posterior Posterior
Upper
trunk
Middle
trunk
Lower
trunk
Trun& %ivision Cords
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Reationship of !ords of bra!hialReationship of !ords of bra!hial
plexus with the axillar* arter*plexus with the axillar* arter*
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ran!hes of the bra!hial plexusran!hes of the bra!hial plexus
Divided intoDivided into
SupraclavicularSupraclavicular branches branches
Infraclavicular branchesInfraclavicular branches
Supraclavicular branchesSupraclavicular branches
arises from roots andarises from roots andtrunk trunk
Infraclavicular branchesInfraclavicular branches
form the cordsform the cords
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SUPRACLAVICULAR BRAC!"SSUPRACLAVICULAR BRAC!"S
# $rom the roots%$rom the roots% Dorsal scapular nerve&C'(Dorsal scapular nerve&C'( A branch to )oin the phrenic nerve&C'( A branch to )oin the phrenic nerve&C'( Lon* thoracic nerve&C'+C,+C-(Lon* thoracic nerve&C'+C,+C-(
.uscular branches to lon*us colli and scaleni.uscular branches to lon*us colli and scaleni
# $rom the trunk&upper trunk($rom the trunk&upper trunk( erve to subclavius&C'+,(erve to subclavius&C'+,(
Suprascapular nerve&C'+,(Suprascapular nerve&C'+,(
ote%.iddle/lo0er trunk does not *ive an1 branchesote%.iddle/lo0er trunk does not *ive an1 branches
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Branches from roots%
1. Long thoracic nerve (C5,6,7)-Descend posterior to the mid a2illar1 lineClosel1 applied to the serratus anterior muscle
Innervates the serratus anterior muscle
2. Dorsal scapular nerve(C5) pierces the Scalenus3medius muscle innervates Rhomboidus ma)or and minor muscles
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Branches from upper trunk%
1. erve to subclavius% &C'+,( -supplies the subclavius muscle
4 contributes&C'( to the phrenic nerve as the accessor1phrenic nerve
2. Suprascapular nerve% &C'+,(
-innervates supraspinatus and infraspinatus muscles of the
scapula
ote% o branches arise from middle / lo0er trunks
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Branches from the cordBranches from the cord
ateral Cordateral Cord (( LLateral pe!toral nerve2C5,6,73ateral pe!toral nerve2C5,6,73
MMus!ulo!utaneous nerve2C5,6,73us!ulo!utaneous nerve2C5,6,73
LLateral root of median nerve2C6,73ateral root of median nerve2C6,73
0edial Cord0edial Cord(( MMedial pe!toral nerve2C8,T13edial pe!toral nerve2C8,T13
MMedial !utaneous nerve of the forearm2C8,T1edial !utaneous nerve of the forearm2C8,T1
MMedial !utaneous nerve of the .rm2C8,T13edial !utaneous nerve of the .rm2C8,T13 UUlnar nerve2C7,C8,T13lnar nerve2C7,C8,T13
MMedial root of median nerve 2C8,T13edial root of median nerve 2C8,T13
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Posterior !ord( Upper sub s!apular nerve 2C5,C63Lower subs!apular nerve 2C5,C63
Thora!o dorsal nerve 2C6,C7,C83
Radial nerve 2C5,C6,C7,C8,T13
Axillar* nerve2 C5,C6
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Branches from the lateral cordBranches from the lateral cord
Lateral pectoral nerveLateral pectoral nerve( supplies( supplies
Pe!toralis "ma4or# minor Pe!toralis "ma4or# minor
Musculocutaneous nerveMusculocutaneous nerve( supplies the( supplies the
mus!le of the anterior !ompartment of armmus!le of the anterior !ompartment of arm
Lateral root of Lateral root of edial nerveedial nerve(supplies the(supplies the
mus!le of forearm !ombined with lateral rootmus!le of forearm !ombined with lateral root
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Branches from the medial cordBranches from the medial cord
Medial root of edianMedial root of edian nervenerve(supplies mus!les of(supplies mus!les of
forearm alon$ with the lateral rootforearm alon$ with the lateral root
Medial cutaneous nerve of theMedial cutaneous nerve of the arar(!utaneous to(!utaneous to
armarm
Medial cutaneous nerveMedial cutaneous nerve of theof the forearforear(!utaneous(!utaneous
to forearmto forearm
Medial pectoralMedial pectoral nervenerve(supplies Pe!toralis"ma4or (supplies Pe!toralis"ma4or and P" minor and P" minor
Ulnar nerve:Ulnar nerve:suppliessupplies the mus!les of forearmthe mus!les of forearm
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Branches from the posterior cordBranches from the posterior cord
Upper subscapular Upper subscapular nervenerve(supplies subs!apularis(supplies subs!apularismus!lemus!le
Lo!er subscapular Lo!er subscapular nervenerve(supplies subs!apularis(supplies subs!apularis
and Teres"0a4orand Teres"0a4or Thoracodorsal nerveThoracodorsal nerve(supplies attisimus"dorsi(supplies attisimus"dorsi Radial nerveRadial nerve(supplies the mus!les of posterior(supplies the mus!les of posterior
!ompartment of arm,!utaneous to arm!ompartment of arm,!utaneous to arm
Axillar" nerveAxillar" nerve(deltoid mus!le#Teres"minor,!utaneous(deltoid mus!le#Teres"minor,!utaneousto the s&in of shoulder to the s&in of shoulder
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Clinical anatomyClinical anatomyUpper trunk injuriesUpper trunk injuries
Lower trunk injuriesLower trunk injuries
Other nerve injuries arising from the plexusOther nerve injuries arising from the plexus
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/pper bra!hial plexus/pper bra!hial plexus/pper bra!hial plexus/pper bra!hial plexus Results from ex!essive displa!ement of the head to the opposite side andResults from ex!essive displa!ement of the head to the opposite side and
depression of the shoulder on the same sidedepression of the shoulder on the same side
Difficult labour Difficult labour Motorc"cle fallMotorc"cle fall
#rb$Duchenne pals"#rb$Duchenne pals"
• Abrasions on the face Abrasions on the face
and shoulder showand shoulder show
how this motorcyclisthow this motorcyclist
pulled his entirepulled his entireplexus apartplexus apart
Malposition of the upperMalposition of the upper
lib on the operation tablelib on the operation table
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/pper bra!hial plexus/pper bra!hial plexus/pper bra!hial plexus/pper bra!hial plexus
The lesion produ!ed is similar to that produ!ed b* a stab or bullet wound inThe lesion produ!ed is similar to that produ!ed b* a stab or bullet wound in
the ne!& affe!tin$ the superior trun& of the bra!hial plexusthe ne!& affe!tin$ the superior trun& of the bra!hial plexus
#rb$Duchenne pals"#rb$Duchenne pals"
%eck !ound%eck !ound
&uperior trunk&uperior trunk
• Affects C5 & C6 roots or theAffects C5 & C6 roots or the superiorsuperior
trunktrunk
• suprascapular nerve, nerve tosuprascapular nerve, nerve to
subclavius, musculocutaneous, andsubclavius, musculocutaneous, and
axillary nerves are affectedaxillary nerves are affected
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rbs pointrbs point
Point on the upper trun&Point on the upper trun&
0eetin$ point of six nerves0eetin$ point of six nerves
C5,6 roots,C5,6 roots, anterior #posterioranterior #posterior
divisionsdivisions
erve toerve to
sub!lavius#supras!apularsub!lavius#supras!apularnervenerve
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/pper bra!hial plexus/pper bra!hial plexus/pper bra!hial plexus/pper bra!hial plexus#rb$Duchenne pals"#rb$Duchenne pals"
• Affects C5 & C6 roots or the upper Affects C5 & C6 roots or the upper
trunk trunk
• suprascapular nerve, nerve tosuprascapular nerve, nerve to
subclavius, musculocutaneous, andsubclavius, musculocutaneous, and
axillary nerves are affectedaxillary nerves are affected
• Abduction, lateral rotation, andAbduction, lateral rotation, and
flexion at the shoulder areflexion at the shoulder are
affectedaffected
• the limb hangs by the sidethe limb hangs by the side
adducted and medially rotated byadducted and medially rotated by
unopposedunopposed pectoralis pectoralis major major
• the forearm extended andthe forearm extended and
pronated because the action ofpronated because the action of
biceps is lostbiceps is lost
'aiter(s tip hand'aiter(s tip hand
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Erbspalsy
Resultin$ from ex!essive displa!ement of head tothe opposite side #depression of the shoulder on the
same side9n4ur* to C5 #C6 nerves .ffe!tin$ mus!les around the shoulder# elbowClini!al features(
:arm is addu!ted # mediall* rotated
:pronated forearm :extended elbow
:hand turns ba!&wards
2waiters tip hand;poli!emans tip hand3
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rbs pals* in new born
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ower bra!hial plexusower bra!hial plexusower bra!hial plexusower bra!hial plexus results froresults fro
excessive abductionexcessive abductionof the ar as inof the ar as in
durin) labour durin) labour
*lupke pals"*lupke pals"
• or when a personor when a person
falls from a heightfalls from a heightgrasping somethinggrasping something
to save himself to save himself
ote the transverse pro!ess of C7
• Cervical ribCervical rib
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ower bra!hial plexusower bra!hial plexusower bra!hial plexusower bra!hial plexusAffects C+,T-Affects C+,T-
Cla! handCla! hand
• Small muscles of the handSmall muscles of the hand
are affected due to paralysisare affected due to paralysis
of ulnar nerveof ulnar nerve
*lupke(s pals"*lupke(s pals"
Note wasting of dorsal interosseiNote wasting of dorsal interossei
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5lumpke6s pals1%
#Resultin* from e2cessive abduction of the arm as in*raspin* somethin* to break a fall
#In)ur1 to C-+C7 /89 nerves
# Affects the muscles of forearm+0rist and hand
#!and has cla0ed appearance due to h1per e2tension
of metacarpo phalan*eal )oints and fle2ion of interphalan*eal )oint &ulnar cla0 hand(
#Loss of sensation alon* the medial aspect of upperlimb
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/lnar !law hand
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:in*in* scapula%
#In)ur1 to the lon* thoracic nervecausin* paral1sis of serratusanterior muscle
#Resultin* from the blo0s on the
posterior trian*le of the neck
#Inabilit1 to protract / rotate thescapula durin* the abduction of the
arm above the head
#.edial border and inferior an*le ofthe scapula elevated
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Brachial ple2us block%Brachial ple2us block%o Site%Site%
Interscalenei&betInterscalenei&betscalenus3anterior/ S3posterior(scalenus3anterior/ S3posterior(
In the supraclavicular trian*leIn the supraclavicular trian*le
Backpacker6s pals1%Back packer6s pals1% Seen in people 0ho carr1Seen in people 0ho carr1
heav1loads at their back especiall1heav1loads at their back especiall1
in hikersin hikers
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Acute brachial ple2us neuritis% Acute brachial ple2us neuritis%o Disorder 0hich is characterised b1 severe pain around theDisorder 0hich is characterised b1 severe pain around the
shoulder follo0ed b1 muscle 0eaknessshoulder follo0ed b1 muscle 0eakness
o Cause %.ostl1 unkno0nCause %.ostl1 unkno0n
$ollo0ed b1 respirator1 infection etc$ollo0ed b1 respirator1 infection etc
!orner6s S1ndrome%!orner6s S 1ndrome%
Cause%Cause%o Dama*e to 89 root of the ple2us +since 89 carries theDama*e to 89 root of the ple2us +since 89 carries the
pre*an*lionic s1mpathetic fibres for head and neckpre*an*lionic s1mpathetic fibres for head and neck
$eatures % Ptosis&droopin* of the e1elid($eatures % Ptosis&droopin* of the e1elid(
.eosis.eosis Anh1drosis Anh1drosis
$lushin* of the face$lushin* of the face
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Than& *ou