Brachial Plexus

This presentation describes the Brachial Plexus , which supplies the nerves to a large part of the human body

Transcript

1. Brachial Plexus
2. It is the network of nerves that supply the whole upper limb except: ➢the trapezius muscle. ➢skin over upper ½ of deltoid muscle.
3. Formation (Parts or Stages) of Brachial Plexus
4. Parts of Brachial Plexus 1- Supra-clavicular part (In the neck): - Roots. - Trunks. 2- Retro-clavicular part (behind clavicle): - Divisions of the trunks. 3- Infra-clavicular part (below clavicle): - Cords and branches of the cords.
5. C5 C6 C7 C8 T1 Clavicle Supra-clavicular part Infraclavicular part Parts of Brachial Plexus Dr. Sherif Fahmy
6. Roots •Ventral primary rami of C5, C6, C7, C8 & T1. Variations: Prefixed type: C4 is added to the roots. Postfixed type: T2 is added to the roots. N.B. Roots of brachial plexus is related to scalenus anterior m. (anterior) & scalenus medius (posterior)m.
7. C5 C6 C7 C8 T1 Roots of Brachial Plexus Roots Dr. Sherif Fahmy
8. Trunks 1- Upper trunk: Union between C5 & C6. 2- Middle trunk: C7 3- Lower trunk: Union between C8 & T1.
9. C5 C6 C7 C8 T1 Trunks of Brachial Plexus Roots Upper trunk Middle trunk Lower trunk Dr. Sherif Fahmy
10. Divisions of the Trunks ➢Behind clavicle (apex of axilla), each trunk divides into anterior and posterior divisions.
11. C5 C6 C7 C8 T1 Roots Trunks Divisions Cords
12. Cords of Brachial Plexus 1- Posterior cord: union between posterior divisions of the 3 trunks. 2- Lateral cord: union between anterior divisions of upper & middle trunks. 3- Medial cord: Anterior division of lower trunk.
13. C5 C6 C7 C8 T1 Lateral cord Posterior cord Upper trunk Middle trunk Lower trunk Medial cord
14. Relations of cords to the Axillary Artery
15. Pectoralis minor m. Lateral cord Posterior cord First part of axillary a. Second part of axillary artery Lateral cord Medial cord 3rd part of axillary artery
16. Branches of Brachial Plexus
17. Branches of Roots of Brachial Plexus 1. Dorsal scapular n. (C5) 2. Nerve to serratus anterior (C5,6 &7) 3. Phrenic nerve (C3,4 &5) 4. Muscular branches to scalenus anterior and medius.
18. Dorsal scapular n. N. To serratus anterior m. Dr. Sherif Fahmy
19. Branches of the upper trunk 1- Nerve to subclavius m. (C5,6). 2- Suprascapular nerve (C5, 6).
20. Suprascapular nerve Nerve to subclavius Dr. Sherif Fahmy
21. Branches of the Lateral cord 1- Lateral pectoral nerve (C5, 6,7). 2- Lateral root of median nerve (C5, 6,7). 3- Musculo-cutaneous nerve (C5, 6,7).
22. Lateral pectoral nerve Lateral root of median nerve Lateral cord Musculo-cutaneous n. Dr. Sherif Fahmy
23. Branches of Medial Cord 1. Medial pectoral nerve (C8, T1) 2. Medial root of median nerve (C8, T1) 3. Ulnar nerve (C7, 8, T1) 4. Medial cutaneous nerve of forearm (C8, T1) 5. Medial cutaneous nerve of arm (C8, T1)
24. Medial cord 1-Medial pectoral nerve 5-Medial cutaneous nerve of arm 4-Medial cutaneous nerve of forearm 3-Ulnar nerve 2-Medial root of median nerve Median nerve Communication between lateral & medial pectoral nerves Dr. Sherif Fahmy
25. Branches of Posterior Cord 1- Upper subscapular nerve (C5, 6) 2- Nerve to latissimus dorsi (C6, 7, 8) 3- Lower subscapular nerve (C5, 6) 4- Axillary (Circumflex) nerve (C5, 6) 5- Radial nerve (C5, 6, 7, 8 & T1)
26. Posterior cord 1-Upper subscaplular nerve 2-Nerve to latissimus dorsi 3-Lower subscapular nerve 4-Axillary (Circumflex) nerve 5-Radial nerve Dr. Sherif Fahmy
27. Posterior cord Upper subscapular n. n. to latissimus dorsi Lower subscapular n. Latissimus dorsi m. Axillary n. Radial n. Teres major M. Subscapularis m.
28. Applied Anatomy Injury of all roots: Paralysis to all muscles of upper limb except trapezius m. Loss of sensation except skin over upper ½ of deltoid. Injury of upper trunk Erb’s paralysis. Injury of Lower trunk: Klumpke’s paralysis.
29. Dr. Sherif Fahmy
30. AXILLARY (CIRCUMFLEX) NERVE (C5,6)
31. Posterior cord Axillary (Circumflex) nerve
32. Posterior cord Axillary n. Subscapularis m. Quadrangular space Dr. Sherif Fahmy
33. Deltoid (cut) Axillary n. Posterior circumflex humeral art. Anterior division of axillary n. Posterior division of axillary n. Upper lateral cutaneous br. Quadrangular space Course of Axillary n.
34. Branches of Axillary Nerve 1- Articular branch. 2- Anterior division that gives: a) Middle and anterior fibers of deltoid m. b) Skin covering lower ½ of anterior fibers of deltoid. 3- Posterior division that gives: a) Posterior fibers of deltoid. b) Teres minor m. c) Upper lateral cutaneous nerve of arm.
35. Injury of Axillary N. Causes: 1- Dislocation of shoulder j. 2- Fracture of surgical neck of humerus. 3- Badly adjusted crutch to armpit. Results: Motor loss: -Paralysis of deltoid and teres minor muscles. Sensory loss: -At skin over lower ½ of deltoid muscle. Disability & deformity: -Unable to abduct arm from 15 – 90 Degrees. -Arm is adducted. Late wasting changes: Wasting of deltoid, flat shoulder and prominent acromion.
36. SUPRASCPULAR NERVE
37. Suprascapular notch
38. Suprascapular n. Suprascapular lig. Suprascapular art. Shoulder j. Acromio-clavicular j. Course of suprascapular n. Axillary n. Supraspinatus m Spino-glenoid notch Infraspinatus m.
39. Spotting
40. Scalenus anterior m. Deltoid m. Pectoralis major m. (cut) Pectoralis minor (cut) Coraco- brachialis m. Axillary artery Dr. Sherif Fahmy
41. Upper trunk Middle trunk Lower trunk Lateral cord Posterior cord Axillary artery Medial cord Musculo-cutaneous n. Median nerve Axillary nerve Radial nerve Ulnar nerve N. To serratus anterior Lateral root Medial root Dr. Sherif Fahmy