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BRACHIAL PLEXUS
the nerve fibers derived from different segments of the spinal cord to be
arranged and distributed efficiently in different nerve trunks to the various
parts of the upper limb.
The brachial plexus is formed in the posterior triangle of the neck by the
union of the anterior rami of the 5th, 6th, 7th, and 8th cervical and the 1st
thoracic spinal nerve
COMPONENTS
Roots – C5 – T1
Trunks – Upper – C5 and C6, Middle – C7, Lower – C8 and T1
Divisions – Anterior and Posterior
Cords –in relation to the AXILLARY ARTERY
– Lateral Cord - anterior divisions of the upper and middle trunk
- Medial Cord - the anterior division of the lower trunk
- Posterior Cord - the posterior divisions of all three trunks
Branches
CORD
lie above and lateral to the first part of the axillary artery
MEDIAL CORD - crosses behind the artery to reach the medial side of the
second part of the artery.
POSTERIOR CORD - lies behind the second part of the artery
LATERAL CORD - on the lateral side of the second part of the artery
form the main nerve trunks of the upper limb continue this relationship to
the artery in its third part.
LATERAL CORD
PARALYSIS
the supraspinatus (abductor of the shoulder)
infraspinatus (lateral rotator of the shoulder)
the subclavius (depresses the clavicle)
the biceps brachii (supinator of the forearm, flexor of the elbow, weak flexor of
the shoulder)
the greater part of the brachialis (flexor of the elbow) and
coracobrachialis (flexes the shoulder);
deltoid (abductor of the shoulder)
teres minor (lateral rotator of the shoulder
UPPER LESIONS OF THE BRACHIAL
PLEXUS
ERB-DUCHENNE PALSY
Upper limb hang limply by the side
medially rotated (due to the the unopposed sternocostal part of the
pectoralis major);
the forearm will be pronated (because of loss of the action of the biceps)
The position of the upper limb in this condition has been likened to that of
a porter or waiter hinting for a tip (WAITER’S TIP APPEARANCE)
there will be a loss of sensation down the lateral side of the arm.
LOWER LESIONS OF THE BRACHIAL
PLEXUS
RADIAL NERVE - commonly damaged in the axilla and in the spiral groove.
AXILLA
- badly fitting crutch pressing up into the armpit or by a drunkard falling asleep
with one arm over the back of a chair – SATURDAY NIGHT PARALYSIS
- badly damaged in the axilla by fractures and dislocations of the proximal end
of the humerus
- The patient is unable to extend the elbow joint, the wrist joint, and the fingers.
- Wristdrop, or flexion of the wrist occurs as a result of the action of the
(unopposed flexors)
LESIONS OF NERVES
RADIAL NERVE -
SPIRAL GROOVE - . The prolonged application of a tourniquet to the arm in
a person and fractures of the shaft of the radius
Motor: The patient is unable to extend the wrist and the fingers, and
wristdrop occurs.
Sensory: A variable small area of anesthesia is present over the dorsal
surface of the hand and the dorsal surface of the roots of the lateral three
and a half fingers..
LESIONS OF NERVES
MUSCULOCUTANEOUS NERVE
the biceps and coracobrachialis are paralyzed and the brachialis muscle
is weakened (the latter muscle is also supplied by the radial nerve)
There is also sensory loss along the lateral side of the forearm
LESIONS OF NERVES
MEDIAN NERVE
MOTOR
The pronator muscles of the forearm and the long flexor muscles of the wrist
and fingers, with the exception of the flexor carpi ulnaris and the medial half of
the flexor digitorum profundus, will be paralyzed.
the forearm is kept in the supine position; wrist flexion is weak and is
accompanied by adduction.
SENSORY
lost on the lateral half or less of the palm of the hand and the palmar aspect of
the lateral three and a half fingers.
also occurs on the skin of the distal part of the dorsal surfaces of the lateral
three and a half fingers
LESION OF NERVES
ULNAR NERVE
- commonly injured at the elbow, where it lies behind the medial
epicondyle, (fractures)
- the wrist, where it lies with the ulnar artery in front of the flexor retinaculum.
(Stab wounds)
LESIONS OF NERVES
ULNAR NERVE
Sensory:
The main ulnar nerve and its palmar cutaneous branch are usually
severed; the posterior cutaneous branch, which arises from the ulnar nerve
trunk about 2.5 in. (6.25 cm) above the pisiform bone, is usually
unaffected.
confined to the palmar surface of the medial third of the hand and the
medial one and a half fingers and to the dorsal aspects of the middle and
distal phalanges of the same fingers.
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