nerve 2-Medial root of median n. 3-Musculo- cutaneous n. 3-Ulnar n. 4-Medial cutaneous n. of arm 5-Medial cutaneous n. of forearm Branches of lateral cord Branches of medial cord
= C5,6 - Any branch from lateral cord= C5,6,7 - Any branch from medial cord= C8,T1 except Ulnar n. (C7,8,T1) - Median & radial nerves = (C5,6,7,8,T1) - Dorsal scapular = C5 - Long thoracic n. = C5,6,7 - N. to latissimus dorsi = C6,7,8
suprspinatus and deltoid. -Paralysis of infraspinatus and teres minor. -Paralysis of biceps and brachialis muscles. Sensory loss: -Loss of sensation on lateral side of upper limb (C5,6) except skin covering upper ½ of deltoid muscle. Disability and deformity: -Disability: unable to abduct arm, laterally rotate arm& week flexion of forearm and week supination of forearm. -Deformity: Arm is adducted and medially rotated. Forearm is extended and pronated. Late wasting changes: Wasting of paralyzed muscles.
and traction of lower trunk (mainly T1) leading to its tear and may occurs due to: -Suspension to an object during falling from a height. -Birth injury. 2-Cervical rib. 3-Malignancy in lower deep cervical lymph nodes.
muscles. Sensory loss: -Loss of sensation (C8, T1) in lower medial side of arm, medial side of forearm, palm and medial 1 & 1/2 fingers Disability and deformity: - Unable to flex metacarpo-phalangeal or extend inter-phalangeal joints. Unable to adduct or abduct medial 4 fingers. - Claw hand (hyperextension of metacarpo-phalangeal joints and flexion of interphalangeal joints. Late wasting changes: -Wasting of lumbricals & interossii muscles of the hand with dorsal hollows
be injuried during radical mastectomy operation. Results: -Motor loss: paralysis of serratus anterior m. -Sensory loss: No loss. -Disability: Weak protraction (pushing or reaching). Weak abduction of arm above 90 degrees. -Deformity: Winging of scapula.
of supraspinatus & infraspinatus ms. Sensory loss: -No sensory loss. Disability : -Loss of abduction from 0 to 15 degrees. Deformity -The arm is adducted and medially rotated. Late wasting changes: -Decrease the size of paralysed muscles.
n. (Supplies middle & anterior fibers of deltoid and skin covering lower half of deltoid.) Posterior division of axillary n. supplies posterior fibers of deltoid snd teres minor muscles Upper lateral cutaneous nerve of arm Quadrangular space Course of Axillary n. Ends behind surgical neck of humerus
gives deltoid and skin over its lower half. 3- Posterior division: gives posterior fibers of deltoid, teres minor muscles and upper lateral cutaneous nerve of arm.
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.
injury: Motor loss: -Paralysis of biceps brachii, medial part of brachialis and coraco-brachialis. Sensory loss: -Loss of sensation on the lateral side of forearm. Disability & deformity: -Weak flexion of elbow and weak supination of forearm. -Forearm is extended and pronated. Late wasting changes: -Wasting of front of arm.
aponeurosis Medial root from medial cord Lateral root from lateral cord 3rd part of axillary artery Median nerve crosses brachial artery at level of insertion of coraco-brachialis m. Lateral Medial
flexor carpi radialis, palmaris longus and flexor digitorum superficialis. Between 2 heads of pronator teres m.: Anterior interosseous branch which supplies flexor pollicis longus, pronator quadratus and lateral ½ of flexor digitorum profundus.
the palm: ➢Gives muscular branches to thenar and 1st two lumbricals. ➢Cutaneous to palmar surfaces of lateral three and half fingers and their distal dorsal parts.
of forearm except flexor carpi ulnaris and medial ½ of flexor digitorum profundus. -Paralysis of thenar muscles with lateral 2 lumbricals. Sensory loss: -Loss of sensation of lateral 2/3 of palm and palmar surfaces of lateral 3&1/2 fingers as well as dorsal surfaces of distal parts. -Disability and deformity: -Loss of pronation. -Weak flexion of wrist with ulnar deviation. -Loss of flexion of index and middle fingers leading to pointing index (on making hand fist). -Loss of flexion and opposition of thumb. -Adducted thumb and loss of opposition leading to ape hand. Late wasting changes: -Wasting of front of forearm except medial side. -Wasting of thenar eminence leading to flat thenar.
lunate, teno-synovitis, edema etc.) Motor loss: -Paralysis of thenar muscles and first 2 lumbricals muscles. Sensory loss: -Loss of sensation in the lateral 3 & ½ fingers and the dorsum of their distal parts. -Disability and deformity: -Loss of opposition, the thumb is laterally rotated. -Adducted thumb leading to ape hand. Late wasting changes: -Wasting of thenar eminence leading to flat thenar.
tunnel syndrome, sensation of the lateral 2/3 of palm is intact. -In cut wrist, there may be loss of sensation in the lateral 2/3 of palm due to possible associated injury of palmar cutaneous branch of median nerve.
supply to palmaris brevis muscle. ➢Palmar cutaneous branches to medial 1&1/2 fingers. Deep branch: ➢All muscles of the hand except thenar and 1st 2 lumbricals. ➢Articular to joints of the hand.
thenar and lateral 2 lumbricals. Sensory loss: -Loss of sensation in the palmar surfaces of medial 1&1/2 fingers. Disability and deformity: -Unable to adduct fingers and can not grip a piece of paper between medial 4 fingers or between thumb and index. -Unable to abduct medial 4 fingers. -Unable to do writing position. -Partial claw hand. Extension of metacarpo-phalangeal joints. Flexion of interphalangeal joint of medial 4 fingers with lesser affection of index and middle fingers. Late wasting changes: -Wasting of hypothenar eminence. -Prominent metacarpal bones due to wasting of dorsal interossii muscles.
of flexor digitorum profundus. -Paralysis of all muscles in the hand except thenar and lateral 2 lumbricals. Sensory loss: -Loss of sensation in medial 1/3 of palm and dorsum of hand. -Loss of sensation in medial 1&1/2 fingers. Disability & Deformity: -As at wrist, loss of adduction of all fingers & loss of abduction of medial 4 fingers. -Weak flexion of wrist with radial deviation due to paralysis of flexor carpi ulnaris muscle. -As in injury at wrist (partial claw hand) but with lesser flexion in ring and little fingers due to paralysis of medial ½ of flexor digitorum profundus muscle (Ulnar paradox). Late wasting changes: -Wasting at the medial side of forearm. -Wasting as with injury at wrist.
Profunda brachii art. Course of Radial Nerve axillary art. Posterior cord of brachial plexus Humerus Lower triangular space Subscapularis m. Lateral Medial Teres major m.
upper 1/3 of arm): 1- N. to long head of triceps. 2- N. to medial head of triceps. 3- Posterior cutaneous n. of arm. 2- Posterior branches (in spiral groove): 1- N. to lateral head of triceps. 2- N. to medial head of triceps. 3- N. to anconeus.and articularis cubitii muscles. 4- Posterior cutaneous n. of forearm. 5- Lower lateral cutaneous n. of arm. 3- Lateral branches (in lower 1/3 of arm): 1- N. to brachialis, brachioradialis and extensor carpi radialis longus. 2- Terminal superficial and deep radial nerves.
muscles of the back of forearm (extensors of the hand and fingers) except brachioradialis, extensor carpi radialis longus and anconeus ms. Superficial radial nerve: It supplies the skin of -Lateral 2/3 of the dorsum of the hand. -Back of lateral 3 and half fingers except terminal parts (from median nerve).
badly adjusted crutch in armpit. B- in upper part of arm: Saturday night palsy. C- In spiral groove: by fracture shaft of humerus. N.B. Main deformity of radial nerve injury is wrist & finger drop (bad hand grip)
at all levels are associated with: -Wrist drop and finger drop. -Loss of sensation of a triangular area between 1st & 2nd metacarpal bones with hypoesthesia on the remaining part of lateral 2/3 of dorsum of the hand. -Unable to supinate extended forearm.
of forearm. Sensory loss: Loss of sensation in skin of: - Back of arm, lower lateral of arm, back of forearm and Loss of sensation of a triangular area between 1st & 2nd metacarpal bones with hypoesthesia on the remaining part of lateral 2/3 of dorsum of the hand. fingers. Disability: Unable to extends forearm against resistance, extends hand against resistance, extends fingers against resistance and supinate extended forearm. Deformity: Flexed elbow with wrist and finger drop. Late wasting changes: Wasting of back of arm & forearm.
and muscles of the back of forearm. Sensory loss: - Loss of sensation in lower lateral of arm, back of forearm. - Loss of sensation of a triangular area between 1st & 2nd metacarpal bones with hypoesthesia on the remaining part of lateral 2/3 of dorsum of the hand. Disability: Weak extension of forearm. Unable to extends hand against resistance, extends fingers against resistance and supinate extended forearm. Deformity: •Flexed elbow with wrist and finger drop. Late wasting changes: •Partial wasting of back of arm and wasting of back of forearm.
the spiral groove Injury in lower part of arm Motor loss Paralysis of triceps and muscles of the back of forearm Paralysis of lateral and part of medial head and muscles of the back of forearm Paralysis of muscles of the back of forearm Loss of sensation in skin of: Back of arm. Lower lateral of arm. Back of forearm. Back of lateral 2/3 of dorsum of hand and lateral 3 and half fingers. Loss of sensation in: Lower lateral of arm. Back of forearm. Back of lateral 2/3 of dorsum of hand and back of lateral 3 and half fingers. Loss of sensation in: Back of lateral 2/3 of dorsum of hand and back of lateral 3 and half fingers. Unable to extends forearm against resistance. Unable to extends hand against resistance. Unable to extends fingers against resistance. Unable to supinate extended forearm Weak extension of forearm. Unable to extends hand against resistance. Unable to extends fingers against resistance. Unable to supinate extended forearm Unable to extends hand against resistance. Unable to extends fingers against resistance. Unable to supinate extended forearm Flexed elbow. Wrist and finger drop. Flexed elbow. Wrist and finger drop. Wrist and finger drop. Wasting of back of arm. wasting of back of forearm. Partial wasting of back of arm. Wasting of back of forearm. Wasting of back of forearm. Sensory loss Disability Deformity Late wasting changes Dr. Sherif Fahmy
area between 1st and 2nd metacarpal bones and dorsum of lateral 3 & ½ fingers except distal parts. -Hypoesthesia (decreased sensation) at the rest of area supplied by the nerve due to overlap of surrounding nerves.
radius. Results of injury: Motor loss: -Paralysis of muscles of back of forearm except brachio-radialis, extensor carpi radialis longus and anconeus muscles. Sensory loss: No sensory loss. Disability & deformity: -Weak extension of wrist with abduction of the hand. -Unable to extends fingers. -Finger drop. -No wrist drop due to action of ext.carpi radialis longus. Late wasting changes: -Wasting of back of forearm with lesser affection to lateral side.
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