BRACHIAL BRACHIAL PLEXUSPLEXUS

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Anatomy

Roots Trunks Division Cord BranchesSympathetic nerves of upper limb –

T2 to T6 pass thru brachial plexus

Roots Ant. Primary rami of C5,6,7,8&T1

with cotribution from C4 & T2 Prefixed or postfixedTrunks C5 & C6 upper trunk C7 middle trunk C8 & T1 lower trunk

Divisions Trunks divides into dorsal &

ventral divisions

Cords Lateral cord – ventral division of

upper & middle trunks

Medial – ventral divisn of lower trunk

posterior – dorsal division of all trunks

Branches of PlexusA. Branches of Roots 1.Long thoracic nerve – N to

serratus anterior (C5,6,7) 2. Dorsal scapular N. – N to

rhomboides (C5)B. Branches of Trunks 1.Suprascapular N. (C5,6) 2. N. to subclavius (C5,6)

C.Branches of cords

(a) lateral cord 1. Lateral pectoral (C5-7) 2.Musculocutaneous(C5-7) 3.Lat. Root of median(C5-7) (b) Medial cord 1.Medial pectoral (C8,T1) 2.Med. Cut. N. of arm(c8,T1) 3.Med. Cut. N. of

forearm(C8,T1)

4.Med. Root of median(C8,T1) 5.Ulnar N.(C7,C8,T1)

(c) Posterior cord 1.Upper subscapular(C5,6) 2.Lower subscapular(C5,6) 3.Axillary/circumflex(C5,6) 4.Thoracodorsal (C6,7,8) N to latissmus dorsi 5.Radial N. (C5-8,T1)

Brachial Plexus Injuries

Causes Closed – birth trauma,bike trauma Open – gunshotTypes Preganglionic- Horners synd. Postganglionic

Investigation

X-ray CT MRI Electrical studies –

EMG,nerve conductn study

Rx

Initial stages1.Splinting Complete paralysis-Flail arm splint Incomplete – modified splints2.pain control –TENS3.Prevent contracture &

deformities- passive exercises

Later stages

1. Strengthen the ms-exercises,PNF2. Re-educatn of ms-movt. Of

shoulder & stimulatn3. Modify the splint & dynamise it4. TENS for pain5. Re-constructive surgery-after 2

yrs

Surgery A/c phases preganglionic-no use postganglionic- suture or N.

graftingLate phase >2yrs Shoulder fn- trapzius to humerus to

improve abductn Elbow fn- Steindler’s flexorplasy For wrist & finger extentn

Erb’s Palsy Site – Erb’s point Causes – Birth injury,Fall on

shoulder, Anaesthetia Nerve root – C5(mainly),C6(partly) Muscle paralysed-

biceps,deltoid,brachialis, brachioradialis,supinator,supra-&infraspinatus

Deformity – policeman’s tip hand

Disability

Abductn & lat. Rotatn of arm Flexion & supinatn of forearm Biceps & supinator jerks Sensatn over lower part of deltoid

Klumpke’s paralysis

Cause –undue abductn of arm,birth injury

Nerve root- T1 & partly C8 Muscles – intrinsic muscles of

hand(T1)& ulnar flexors of wrist and hand(C8)

Deformity – Claw hand

CLAW HAND

Injury to N of Bell winging of scapula

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