Julie Cornish

Brachial PlexusRoots (C5-T1)Trunks

Upper trunk (C5-6)Middle trunk (C7)Lower trunk (C8, T1)

DivisionsAnteriorposterior

CordsLateral (ant. divisions of upper and middle trunk)Medial (ant. division of lower trunk)Posterior (post. divisions of all 3 trunks)

relation to axillary arteryAll 3 cords lie above and lateral to 1st part2nd part of axillary artery

medial cord crosses behind to medial sideposterior cord lies behind itlateral cord lies on lateral side of artery

3rd partgenerally continue in same relationship

What is the surgical relevance?Breast Ca – axillary node clearanceTrauma to shoulder and head

Erbs palsy – obstetric injuryParsonage-Turner Syndrome

Sentinel lymph node biopsy

1. Lateral cord 2. Posterior cord 3. Medial cord 4. Lateral root of median

nerve 5. Medial root of median

nerve 6. Radial nerve 7. Ulnar nerve 8. Median nerve

Brachial nerve injuryHow to determine site of injury?

assess muscle functionIs injury pre-ganglionic /post ganglionic?post ganglionic (distal to DRG) = better prognosissurgical repair / grafting occ. possible

Horners syndromedrooping eyelidsmall pupilno sweating on surrounding skinprotrusion of eyeball

Median nerve (C5 – T1)innervates all of the flexors in the forearm

(except flexor carpi ulnaris) + part of flexor digitorum profundus that

supplies the medial two digits

Median nerve injuryabove the elbow loss of pronation and a

reduction in flexion of the hand at the wristpronator teres syndrome (pain on resisted

pronation)anterior interosseous syndrome (pinch test)carpal tunnel syndromehand of benediction ape hand deformity

Radial nerve (C5-T1)largest branch of plexusdescends down spiral groove in humerus

injury may occur at any point along the nerveproximal forearm in the area of the supinator

musclefractures of the humerus at the junction of the

middle and proximal thirdsdistally on the radial aspect of the wrist

Saturday night syndromecompression of the lower part of the brachial plexus.acquired by sleeping with the arm over the back of a

chair whilst in a drunken stuporalso found in use of shoulder crutchesa brachial plexus injury and the median and ulnar

nerves may also be involved.nerve function usually fully recovers within a few

weeks

Ulnar nerve (C8, T1) descends between axillary artery and veinno branches in axilla

injury:trauma, e.g. # /dislocation of elbowentrapmentlocal inflammation of surrounding structures

Erb Duchenne Palsy“waiters tip”injury to upper brachial plexus= excessive displacement of head to opposite

side + depression of shoulder same sideinfants – difficult deliveryadults – following blow or fall

medial rotation, pronation of forearm and loss of sensation lateral side of arm

Klumpke palsylesion of lower brachial plexususually traction injury due to excessive

traction of armE.g. falling from height and clutching object

other causescervical rib / malignant mets

Claw handhyperextension of MTPJ and flexion of IPJ