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The Brachial Plexus

Dr. Margret C. Licup


September 2, 2011

The Brachial Plexus


Formed by the anterior rami of C5 through T1 spinal nerves Supply all the muscles of the upper limb Variations: o Prefixed-C4 through C8 o Postfixed- C6 through T2

Topographical Divisions
Root Trunks o Upper/middle/ lower Cords o Lateral/medial/posterior Branches

Principal Nerves of the Upper Extremity(please refer to Snell book for the branches of the nerves listed below)
Radial nerve Median nerve Ulnar nerve The trunks may be affected in injuries above the clavicle The cords may be injuries below the clavicle The peripheral nerves may be involved more distal lesions, as they emerge between the clavicle and the axilla

Brachial Plexus Injury


Injury to the ROOTS o Complete paralysis of upper extremity o Scapular winging Upper Trunk Injury o Aka Erb-Duchenne paralysis o Usually caused by violent downward displacement of the arm o Loss of abduction, external rotation, and radial flexion Waters tip position Lower Trunk Injury o Aka KLUMPKES paralysis o Caused by violent upward displacement of the arm o Loss of ulnar wrist flexion and intrinsic muscles claw like position Axially nerve injury o Loss of shoulder abduction (deltoid involvement) o Weak external rotation Posterior Cord Injury o Aka Saturday night/Crutch Palsy o Loss of extension of elbow, wrist, and hand Anterior Interosseus Nerve Palsy o Causes weak flexor pollicis longus

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o Failure of DIP flexion CTS- Carpal Tunnel Syndrome o Thenar wasting o Failure of opposition (thumb and pinkie) flexion only

Median nerve damage(unable to do flexion theoretically but because there is still innervation by the ulnar nerve, so pwede pa slight flexion)

MUSCLES OF THE SHOULDER GIRDLE AND UPPER EXTREMITY

Nerve Radial nerve

C5 C6 Brachioradialis Extensor carpi radialis Longus brevis Triceps Anconeus Suppinator

C7

C8

T1

Posterior nerve

interosseous Extensor carpi ulnaris Extensor digitorum Extensor digiti minimi Abductor pollicis longus Extensor pollicis Longus brevis Extensor indices

Median nerve

Anterior nerve

interosseous

Ulnar nerve

Pronator Teres Flexor carpi radiais Palmaris longus Flexor digitorum sublimis Abductor pollicis brevis Flexor pollicis brevis (superficial) Lumbricals 1&2 Opponens pollicis Flexor digitorum profundus (1&2) Flexor pollicis longus Pronator quadratus Flexor digitorum profundus 3&4 Flexor carpi ulnaris Adductor pollicis Flexor pollicis brevis (deep head) Abductor digiti minimi Opponens digiti minimi Flexor digiti minimi Volar and dorsal interosseous Lumbricals 3&4

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Nerve Dorsal Scapular Suprascapular Axillary Subscapula Musculocutaneous Long Thoracic Anterior Thoracic

Thoracodorsal

C4 C5 C6 C7 C8 Levator scapular Rhomboids Supraspinatus Infraspinatus Teres minor Deltoids Teres major Brachialis, biceps brachi Corachobrachialis Serratus anterior Pectoralis major (clavivular part) Pectoralis major (sternocostal part) Pectoralis minor Latissimus dorsi

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