Brachial Plexus Lecture

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



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



RReall*eall* TTired+ired+ %%rin&rin& CCoffee,offee,

udd*-udd*-

RRootsoots

TTrunksrunks

DDivisionsivisions

CCordsordsBBranchesranches



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



.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



Reationship of !ords of bra!hialReationship of !ords of bra!hial

plexus with the axillar* arter*plexus with the axillar* arter*



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



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



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



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



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



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



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



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



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



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



/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



/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



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



/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

http://d/PPT%20lectures/Upperlimb%20classes/C15.ppt#Slide%205








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



rbs pals* in new born



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



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



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



/lnar !law hand



: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



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



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



Than& *ou

Brachial Plexus Lecture

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