durere umar
TRANSCRIPT
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Upper extremity
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Surface anatomy
Clavicle Manubrium Jugular notch (suprasternal notch) Deltoids Scapula, Acromion, spine, coracoid process, fossa,
borders Humerus, tubercle, body Ulna, head, olecranon process, ulnar nerve Radius, radial nerve, styloid process Carpals, pisiform, scaphoid and trapezium, anatomical
snuff box
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Brachial Plexus
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Brachial plexus formation.
The brachial plexus starts from the five ventralrami of the spinal nerves, after they have given
off their segmental supply to the muscles of theneck. These are the five roots.
These roots merge to form three trunks:"superior" or "upper" C5-C6, "middle" C7, and
"inferior" or "lower" C8-T1.
Each trunk then splits to form an anterior and aposterior division.
http://en.wikipedia.org/wiki/Spinal_nervehttp://en.wikipedia.org/wiki/Neckhttp://en.wikipedia.org/wiki/Neckhttp://en.wikipedia.org/wiki/Spinal_nerve -
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Brachial plexus formation.
The six divisions will regroup to become thecords. The cords are named by their position inrespect to the axillary artery.
The posterior cordis formed from the threeposterior divisions of the trunks.
The lateral cordis the anterior divisions from the
upper and middle trunks. The medial cordis simply a continuation of the
lower trunk.
http://en.wikipedia.org/wiki/Axillary_arteryhttp://en.wikipedia.org/wiki/Posterior_cordhttp://en.wikipedia.org/wiki/Lateral_cordhttp://en.wikipedia.org/wiki/Medial_cordhttp://en.wikipedia.org/wiki/Medial_cordhttp://en.wikipedia.org/wiki/Lateral_cordhttp://en.wikipedia.org/wiki/Posterior_cordhttp://en.wikipedia.org/wiki/Axillary_artery -
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Brachial plexus formation
Branches of the brachial plexus
3 branches from the roots
Dorsal scapular nerve arises from C5root, supplies the rhomboid musclesand levator
scapulae.
Nerve to subclavius arises from C5and C6roots, supplies the subclavius muscle
Long thoracic nerve arises from C5, C6and C7roots, supplies serratus
anterior
http://en.wikipedia.org/wiki/Dorsal_scapular_nervehttp://en.wikipedia.org/wiki/C5http://en.wikipedia.org/wiki/Rhomboid_musclehttp://en.wikipedia.org/wiki/Levator_scapulaehttp://en.wikipedia.org/wiki/Levator_scapulaehttp://en.wikipedia.org/wiki/Nerve_to_subclaviushttp://en.wikipedia.org/wiki/Nerve_to_subclaviushttp://en.wikipedia.org/wiki/C5http://en.wikipedia.org/wiki/C6http://en.wikipedia.org/wiki/Subclavius_musclehttp://en.wikipedia.org/wiki/Long_thoracic_nervehttp://en.wikipedia.org/wiki/Long_thoracic_nervehttp://en.wikipedia.org/wiki/C5http://en.wikipedia.org/wiki/C6http://en.wikipedia.org/wiki/C7http://en.wikipedia.org/wiki/Serratus_anteriorhttp://en.wikipedia.org/wiki/Serratus_anteriorhttp://en.wikipedia.org/wiki/Serratus_anteriorhttp://en.wikipedia.org/wiki/Serratus_anteriorhttp://en.wikipedia.org/wiki/C7http://en.wikipedia.org/wiki/C6http://en.wikipedia.org/wiki/C5http://en.wikipedia.org/wiki/Long_thoracic_nervehttp://en.wikipedia.org/wiki/Long_thoracic_nervehttp://en.wikipedia.org/wiki/Subclavius_musclehttp://en.wikipedia.org/wiki/C6http://en.wikipedia.org/wiki/C5http://en.wikipedia.org/wiki/Nerve_to_subclaviushttp://en.wikipedia.org/wiki/Nerve_to_subclaviushttp://en.wikipedia.org/wiki/Levator_scapulaehttp://en.wikipedia.org/wiki/Levator_scapulaehttp://en.wikipedia.org/wiki/Rhomboid_musclehttp://en.wikipedia.org/wiki/C5http://en.wikipedia.org/wiki/Dorsal_scapular_nerve -
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Brachial plexus formation
1 branch from the trunks
Suprascapular nerve arises from the superior trunk, supplies supraspinatusand
infraspinatusmuscles
3 branches from the lateral cord Lateral pectoral nerve
supplies pectoralis majorand pectoralis minor( bycommunicating with the medial pectoral nerve) from C5, C6, C7.
Musculocutaneous nerve from C5 and C6 it supplies coracobrachialis, brachialisand biceps
brachii. It then becomes the lateral cutaneous nerve of theforearm.
Lateral root of the median nerve
supplies C5, C6 and C7 fibres to the median nerve.
http://en.wikipedia.org/wiki/Suprascapular_nervehttp://en.wikipedia.org/wiki/Supraspinatushttp://en.wikipedia.org/wiki/Infraspinatushttp://en.wikipedia.org/wiki/Lateral_pectoral_nervehttp://en.wikipedia.org/wiki/Pectoralis_majorhttp://en.wikipedia.org/wiki/Pectoralis_minorhttp://en.wikipedia.org/wiki/Medial_pectoral_nervehttp://en.wikipedia.org/wiki/Musculocutaneous_nervehttp://en.wikipedia.org/wiki/Musculocutaneous_nervehttp://en.wikipedia.org/wiki/Coracobrachialishttp://en.wikipedia.org/wiki/Brachialishttp://en.wikipedia.org/wiki/Biceps_brachiihttp://en.wikipedia.org/wiki/Biceps_brachiihttp://en.wikipedia.org/wiki/Lateral_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Lateral_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Lateral_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Lateral_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Biceps_brachiihttp://en.wikipedia.org/wiki/Biceps_brachiihttp://en.wikipedia.org/wiki/Brachialishttp://en.wikipedia.org/wiki/Coracobrachialishttp://en.wikipedia.org/wiki/Musculocutaneous_nervehttp://en.wikipedia.org/wiki/Musculocutaneous_nervehttp://en.wikipedia.org/wiki/Medial_pectoral_nervehttp://en.wikipedia.org/wiki/Pectoralis_minorhttp://en.wikipedia.org/wiki/Pectoralis_majorhttp://en.wikipedia.org/wiki/Lateral_pectoral_nervehttp://en.wikipedia.org/wiki/Infraspinatushttp://en.wikipedia.org/wiki/Supraspinatushttp://en.wikipedia.org/wiki/Suprascapular_nerve -
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Brachial plexus formation
5 branches from the posterior cord Upper subscapular nerve
supplies subscapularis(upper part) from C5 and C6 Thoracodorsal nerve
supplies latissimus dorsiwith nerve fibres from C6, C7 and C8 Lower subscapular nerve
supplies the lower part of subscapularis and teres majorfrom C5 andC6.
Axillary nerve from C5 and C6, it supplies deltoidand a small area of overlying skin by
its anterior branch. Its posterior branch supplies teres minorand deltoid muscles then
becomes the upper lateral cutaneous nerve of the arm Radial nerve
nerve fibres from all 5 roots (C5-T1) largest nerve of the plexus supplies tricepsbrachii, the skin of theposteriorarm as the posterior
cutaneous nerve of the arm, anconeus, and the extensor musclesof the
forearm.
http://en.wikipedia.org/wiki/Upper_subscapular_nervehttp://en.wikipedia.org/wiki/Subscapularishttp://en.wikipedia.org/wiki/Thoracodorsal_nervehttp://en.wikipedia.org/wiki/Thoracodorsal_nervehttp://en.wikipedia.org/wiki/Latissimus_dorsihttp://en.wikipedia.org/wiki/C8http://en.wikipedia.org/wiki/Lower_subscapular_nervehttp://en.wikipedia.org/wiki/Lower_subscapular_nervehttp://en.wikipedia.org/wiki/Teres_majorhttp://en.wikipedia.org/wiki/Axillary_nervehttp://en.wikipedia.org/wiki/Axillary_nervehttp://en.wikipedia.org/wiki/Deltoidhttp://en.wikipedia.org/wiki/Upper_lateral_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Upper_lateral_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Upper_lateral_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Upper_lateral_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Radial_nervehttp://en.wikipedia.org/wiki/Radial_nervehttp://en.wikipedia.org/wiki/T1http://en.wikipedia.org/wiki/Posterior_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Posterior_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Posterior_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Anconeushttp://en.wikipedia.org/wiki/Extensor_musclehttp://en.wikipedia.org/wiki/Extensor_musclehttp://en.wikipedia.org/wiki/Posterior_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Forearmhttp://en.wikipedia.org/wiki/Posterior_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Anconeushttp://en.wikipedia.org/wiki/Extensor_musclehttp://en.wikipedia.org/wiki/Forearmhttp://en.wikipedia.org/wiki/Forearmhttp://en.wikipedia.org/wiki/Extensor_musclehttp://en.wikipedia.org/wiki/Anconeushttp://en.wikipedia.org/wiki/Posterior_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Posterior_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Tricepshttp://en.wikipedia.org/wiki/T1http://en.wikipedia.org/wiki/Radial_nervehttp://en.wikipedia.org/wiki/Radial_nervehttp://en.wikipedia.org/wiki/Upper_lateral_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Teres_minorhttp://en.wikipedia.org/wiki/Deltoidhttp://en.wikipedia.org/wiki/Axillary_nervehttp://en.wikipedia.org/wiki/Axillary_nervehttp://en.wikipedia.org/wiki/Teres_majorhttp://en.wikipedia.org/wiki/Lower_subscapular_nervehttp://en.wikipedia.org/wiki/Lower_subscapular_nervehttp://en.wikipedia.org/wiki/C8http://en.wikipedia.org/wiki/Latissimus_dorsihttp://en.wikipedia.org/wiki/Thoracodorsal_nervehttp://en.wikipedia.org/wiki/Thoracodorsal_nervehttp://en.wikipedia.org/wiki/Subscapularishttp://en.wikipedia.org/wiki/Upper_subscapular_nerve -
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Brachial plexus formation
5 branches from the medial cord medial pectoral nerve
from C8 and T1, it supplies pectoralis majorand pectoralis minor
medial root of the median nerve supplies C8 and T1 fibres to the median nerve.
medial cutaneous nerve of the arm supplies the front and medial skin of the armfrom C8 and T1
medial cutaneous nerve of the forearm supplies medial skin of the forearm from C8 and T1
ulnar nerve C7, C8 and T1 fibres
supplies flexor carpi ulnaris, the medial 2 bellies of flexor digitorumprofundus, most of the small muscles of the handand the skin ofthe medial side of the hand and medial one and a half fingers
http://en.wikipedia.org/wiki/Medial_pectoral_nervehttp://en.wikipedia.org/wiki/Pectoralis_majorhttp://en.wikipedia.org/wiki/Pectoralis_minorhttp://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Armhttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Ulnar_nervehttp://en.wikipedia.org/wiki/Ulnar_nervehttp://en.wikipedia.org/wiki/Flexor_digitorum_profundushttp://en.wikipedia.org/wiki/Flexor_digitorum_profundushttp://en.wikipedia.org/wiki/Flexor_carpi_ulnarishttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Flexor_digitorum_profundushttp://en.wikipedia.org/wiki/Flexor_digitorum_profundushttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Flexor_digitorum_profundushttp://en.wikipedia.org/wiki/Flexor_digitorum_profundushttp://en.wikipedia.org/wiki/Flexor_carpi_ulnarishttp://en.wikipedia.org/wiki/Ulnar_nervehttp://en.wikipedia.org/wiki/Ulnar_nervehttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_forearmhttp://en.wikipedia.org/wiki/Armhttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Medial_cutaneous_nerve_of_the_armhttp://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Pectoralis_minorhttp://en.wikipedia.org/wiki/Pectoralis_majorhttp://en.wikipedia.org/wiki/Medial_pectoral_nerve -
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Anesthesia of the Brachial Plexus
The fact that the nerves of the brachial plexus aregrouped together acts as a benefit as well. Localanestheticssuch as lidocaineor bupivacainecan beinjectedin close proximity to these nerves, rendering anentire arm insensate and immobile. The process ofinjecting local anesthetic for this purpose is calledregional nerve blockadeor more simply, a nerve block,and it is a common procedure in anesthesia. After anonset time of approximately 10 to 15 minutes, the
targeted arm will be fully anesthetized and ready forsurgery. The patient can remain awake during theensuing surgical procedure, or he can be sedated withmedications or fully anesthetized with general anesthesia
http://en.wikipedia.org/wiki/Local_anesthetichttp://en.wikipedia.org/wiki/Local_anesthetichttp://en.wikipedia.org/wiki/Lidocainehttp://en.wikipedia.org/wiki/Bupivacainehttp://en.wikipedia.org/wiki/Bupivacainehttp://en.wikipedia.org/wiki/Local_anesthetichttp://en.wikipedia.org/wiki/Injecthttp://en.wikipedia.org/wiki/Local_anesthetichttp://en.wikipedia.org/wiki/Lidocainehttp://en.wikipedia.org/wiki/Bupivacainehttp://en.wikipedia.org/wiki/Nervehttp://en.wikipedia.org/wiki/Bupivacainehttp://en.wikipedia.org/wiki/Injecthttp://en.wikipedia.org/wiki/Nervehttp://en.wikipedia.org/wiki/Regional_nerve_blockadehttp://en.wikipedia.org/wiki/Regional_nerve_blockadehttp://en.wikipedia.org/wiki/Anesthesiahttp://en.wikipedia.org/wiki/Anesthesiahttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/General_anesthesiahttp://en.wikipedia.org/wiki/General_anesthesiahttp://en.wikipedia.org/wiki/General_anesthesiahttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Anesthesiahttp://en.wikipedia.org/wiki/Regional_nerve_blockadehttp://en.wikipedia.org/wiki/Nervehttp://en.wikipedia.org/wiki/Injecthttp://en.wikipedia.org/wiki/Bupivacainehttp://en.wikipedia.org/wiki/Lidocainehttp://en.wikipedia.org/wiki/Local_anesthetichttp://en.wikipedia.org/wiki/Local_anesthetic -
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Peripheral nerve blockade The use of peripheral nerve blockade (in this case, a "brachial plexus nerveblock") offers several advantages when compared to general anesthesia or
local anesthesia: The patient can remain awake and breathing on their own, thus protecting
themselves from aspiration of stomach contents into the lungs. By avoidinggeneral anesthesia, patients with adverse reactions to general anesthetics(viz.malignant hyperthermia, severe post-operative nausea and vomiting,
known hypersensitivity to agents) can be successfully treated. Similarly,patients who experience nuisance side effects from general anesthesia suchas nausea, vomiting, or excessive sleepiness can minimize these symptoms.
There is no need to perform an endotracheal intubation, the procedure ofinserting a breathing tube into the trachea. Occasionally, such intubation isunexpectedly difficult to perform, causing injury to the patient.
The affected limb's sympathetic nervesare anesthetized, leading to
vasodilation. This improves blood flowto the affected limb and makesmicrovascular surgical procedures technically simpler.
The limb can remain numb for several hours after surgery, providingexcellent pain relief.
Deep and superficial structures of the limb are similarly anesthetized,allowing extensive surgical explorationand correction to occur. This is incontrast to locally injected local anesthetics, which tend only to numb
superficial structures in the immediate vicinity of the injection.
http://en.wikipedia.org/wiki/Endotracheal_intubationhttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/wiki/Sympathetic_nervehttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Sympathetic_nervehttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/w/index.php?title=Surgical_exploration&action=edithttp://en.wikipedia.org/w/index.php?title=Surgical_exploration&action=edithttp://en.wikipedia.org/w/index.php?title=Surgical_exploration&action=edithttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/wiki/Sympathetic_nervehttp://en.wikipedia.org/wiki/Endotracheal_intubation -
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Brachial plexus blockade
Brachial plexus blockade is the preferred anesthetic technique when: Surgery is expected to be limited either to a region between the midpoint of
the humerusand the fingers(in which casethe brachial plexus block shouldbe either a supra-clavicular, infra-clavicular, subcoracoid, or axillary block),OR surgery is expected to be limited to a region between the midpoint ofthe humerus and the shoulder (in which case the brachial plexus blockshould be an interscalene block). Because of the distribution of the local
anesthetics on the various portions of the brachial plexus, surgeriescrossing the midpoint of the humerus often reveal patchy, unanesthetizedportions of the arm. Such procedures probably should not be performedunder regional nerve block alone.
AND There are no contra-indications to a block such as infection at the intended
injection site, significant anti-coagulation, allergyor hypersensitivityto local
anesthetic medications, or disproportionate risk in the eventof a localanesthetic toxic reaction (seizure) such as gastric aspirationin a patientwho has not adequately fasted,
AND There will not be a need to perform a neurologic examinationimmediately
following the surgical procedure, AND Patient prefers this technique over other available and reasonable
http://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Fingerhttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/w/index.php?title=Supra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Supra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Supra-clavicular&action=edithttp://en.wikipedia.org/wiki/Fingerhttp://en.wikipedia.org/w/index.php?title=Infra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Supra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Infra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Anti-coagulation&action=edithttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/w/index.php?title=Anti-coagulation&action=edithttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/wiki/Seizurehttp://en.wikipedia.org/w/index.php?title=Gastric_aspiration&action=edithttp://en.wikipedia.org/wiki/Seizurehttp://en.wikipedia.org/w/index.php?title=Gastric_aspiration&action=edithttp://en.wikipedia.org/w/index.php?title=Neurologic_examination&action=edithttp://en.wikipedia.org/w/index.php?title=Neurologic_examination&action=edithttp://en.wikipedia.org/w/index.php?title=Gastric_aspiration&action=edithttp://en.wikipedia.org/wiki/Seizurehttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/w/index.php?title=Anti-coagulation&action=edithttp://en.wikipedia.org/w/index.php?title=Anti-coagulation&action=edithttp://en.wikipedia.org/w/index.php?title=Anti-coagulation&action=edithttp://en.wikipedia.org/w/index.php?title=Infra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Infra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Infra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Supra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Supra-clavicular&action=edithttp://en.wikipedia.org/w/index.php?title=Supra-clavicular&action=edithttp://en.wikipedia.org/wiki/Fingerhttp://en.wikipedia.org/wiki/Humerus -
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Injuries
Two injuries types are recognised in brachial plexusinjuries: Traumautic and Obstetric.
Traumatic injuries often are the result of high velocity
RTA's (Road Traffic Injuries). The most common form ofinjury are the motorcycle drivers falling, with either thehead/neck pushed to the side (upper plexus lesions) orwith their arm abducted (stretched upwards) whichproduces a lower plexus injury.
The brachial plexus is susceptible to injuries thatproduce abduction of the thoracic limb from the bodywall or a direct blow to the lateral surface of the scapula.
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The cardinal signs of brachial
plexus avulsion are: a weaknessin the arm diminished reflexes corresponding sensory deficits The nerve roots are stretched or torn from their origin by this
trauma, since the meningeal coverings of the nerve roots arethinner than those in the peripheral nerve. The epineuriumof theperipheral nerve is contiguous with the dural mater, providing extrasupport to the peripheral nerves. In cases where the nerve rootshave been torn, recovery is unlikely without new experimentalsurgical techniques.
The diagnosis may be confirmed by an EMGexamination in 5-7days. The evidence of denervation will be evident. If there is nonerve conduction 72 hours after the injury, then avulsionis mostlikely.
http://en.wikipedia.org/wiki/Weaknesshttp://en.wikipedia.org/wiki/Reflexeshttp://en.wikipedia.org/w/index.php?title=Sensory_deficits&action=edithttp://en.wikipedia.org/wiki/Epineuriumhttp://en.wikipedia.org/wiki/Dural_materhttp://en.wikipedia.org/wiki/Dural_materhttp://en.wikipedia.org/wiki/Epineuriumhttp://en.wikipedia.org/wiki/Dural_materhttp://en.wikipedia.org/wiki/Electromyographyhttp://en.wikipedia.org/wiki/Avulsionhttp://en.wikipedia.org/wiki/Avulsionhttp://en.wikipedia.org/wiki/Avulsionhttp://en.wikipedia.org/wiki/Electromyographyhttp://en.wikipedia.org/wiki/Dural_materhttp://en.wikipedia.org/wiki/Epineuriumhttp://en.wikipedia.org/w/index.php?title=Sensory_deficits&action=edithttp://en.wikipedia.org/wiki/Reflexeshttp://en.wikipedia.org/wiki/Weakness -
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Brachial Plexus and Nerves of Upper limb
Supraclavicular nerve
Origin Muscle distribution
Dorsal scapular Ventral rami of C4, C5 Rhomboids & Lev. scapulae
Long thoracic Ventral rami of C4- C7 Serratus anterior
Nerve to subclavius Superior trunk, C4- C6 Subclavius, sternoclavicular joint
Suprascapular Superior trunk, C4-C6 Supraspinatus, infraspinatus,glenohumeral (shldr) joint
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Infraclavicular
nerves Origin Muscle distribution
Lateral pectoral Lateral cord, C5-C7 Pectoralis major, pectoralis minorMusculocutane
ous Lateral cord, C5-C7 Coracobrachialis, biceps brachii,brachialis,Median Lateral cord, C6-C7 Flexor carpi ulnaris, flexor
digitorum profundusMedial pectoral Medial cord, C8-T1 Pectoralis major/minorMedial brachial
cutaneous Medial cord C8-T1 Skin on medial side of arm.
Medial
antebrachial
cutaneousMedial cord, C8-T1 Skin over medial side of forearm
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Infraclavicular
nerve Origin Muscle distributionUlnar Terminal of medial cord,
C7, C8- T1 Half of flexor forearm muscles,
small muscles of hand, skin onmedial of hand to ring fingerUpper subscapular Posterior cord, C5-C6 Superior subscapularisThoracodorsal Posterior cord, C6-C8 Latissimus dorsiLower
subscapularPosterior cord, C5-C6 Inferior subscapularis and teres
majorAxillary Terminal posterior cord,
C5- C6 Teres minor, deltoids, shoulderjoints, skin over inferiordeltoids.
Radial
Terminal posterior cord,C5- C6 Triceps brachii, anconeus,brachioradialis, extensor
muscles of forearm, skin over
post. Aspect of arm and
forearm.
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Muscle Origin Insertion Nerve ActionBiceps brachii Coracoid
process,
supraglenoid
tubercle
Radial
tuberosity,
biciptal
aponeurosis
Musculocutaneo
us
C5C6Supinates
forearm, flexes
forearmBrachialis Anterior surface
of distal
humerusCoronoid
process, ulna
tuberosityMusculocutaneo
us
C5C6Flex and
adducts armsCracobrachialis Coronoid
process of
scapulaMid3rd medial
surface humerus MusculocutaneousC5C7
Flex and
adducts armTriceps brachii LH:Infraglenoid
tubercle
Lat hd: post
humerus sup. To
radial groove
Medial Hd:
post. Humerus
inf. To radialgroove
Olecranon ofulna and fascia
of forearmRadial nerve C6C8 Extend forearm,long head
steadies head of
humerus
Anconeus Lateralepicondyle
HumerusLat. Surface
olecranon sup
of ulnaRadial nerve C7
T1 Assist triceps toextend forearm,stabilize elbow,
adducts ulna in
pronation
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Break
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Axillary artery
Boundaries = lateral border first rib to superior border of Teres minor muscle Division: 1st division = from lateral border first rib to medial border of pectoralis minor Branch = supreme thoracic artery 2nd division = from medial border of pectoralis muscle to lateral border of same
muscle Branch = Thoraco acromial artery Lateral thoracic artery 3rd division = from lateral border of pectoralis minor to superior border of the Teres
minor muscle Branch = Subscapular artery Anterior circumflex humeral artery Posterior circumflex humeral artery
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Brachial artery
Boundaries = distal edge of Teres major muscle to Cubital fossa. Branches = 1. Deep brachial or Profunda brachii artery = to
posterior compartment of the arm Recurrent branch anastomose with the posterior circumflex humeral
artery Lateral branch anastomose with the Radial recurrent artery. Posterior branch anastomose with Recurrent interosseous artery. Collateral branches
Superior ulnar artery anastomose with posterior recurrent ulnar artery. Inferior ulnar artery anastomose with anterior recurrent ulnar artery.
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Venous return
Deep veins = 2 to 3 joins to form the venaecomitantes brachiales freely anastomose about thebrachial artery.
superficial veins Cephalic veins to the anterior of the lateral epicondyle to thedeltopectoral triangle, pierces the clavipectoral fascia to jointhe axillary vein distal to first rib..
Basilic vein = medial epicondyle along the deep medialantebrachial joins the brachial vein near the teres majormuscle to form the axillary veins.
Median cubital veins = the connecting veins betweenthe cephalic and the basilica veins at the cubital
Fossa, it lies at the bicipital aponeurosis..
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Lymphatic drainage
Deep lymphatics accompany brachial veinsinto the axillary lymph nodes.
Superficial lymphatics along the superficialveins into the:
supratrochlear lymph nodes near the medial
epicondyle superficial drainage bypass most axillary
nodes into the subclavian vein.
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Ligaments of the Glenohumeral
Joint. There are several important ligaments in the
shoulder. Ligaments are soft tissue structures thatconnect bones to bones. A joint capsule is awatertight sac that surrounds a joint. In theshoulder, the joint capsule is formed by a group ofligaments that connect the humerus to the glenoid.These ligaments are the main source of stability forthe shoulder. They help hold the shoulder in place
and keep it from dislocating. These are theglenohumeral ligaments (GHL)
Another ligament links the coracoid to the acromion- coracoacromial ligament (CAL). This ligament canthicken and cause Impingement Syndrome
Ligaments attach the clavicle to the acromion in theAC joint.
Two ligaments connect the clavicle to the scapulaby attaching to the coracoid process, a bony ridgeon the scapula - coracoclavicular ligaments (CCL)
Ligaments of the Shoulder Complex: CCL - coracoclavicular ligaments CAL - coracoacromial ligaments SGHL - Superior GlenoHumeral Ligament MGHL - Muperior GlenoHumeral Ligament IGHL - Inferior GlenoHumeral Ligament
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Ligaments of the Rotator Cuff
The tendons of the rotator cuff are the next layer inthe shoulder joint. Tendons are much likeligaments, except that tendons attach muscles tobone. Muscles move the bones by pulling on thetendons. One important tendon that travels throughthe shoulder joint is the biceps tendon . Thebiceps tendon actually begins at the top of theshoulder socket (the glenoid) and then passes
across the front of the shoulder to connect to thebiceps muscle. (The biceps is the muscle thatweightlifters are always showing off).
The rotator cuff tendons are a group of fourtendons that connect the deepest layer of musclesto the humerus. They are the tendons of therotator cuff muscles (left)
Tendons of the shoulder: From front to back: Subscapularis Biceps Tendon Supraspinatus Infraspinatus Teres Minor
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Deep ( Intrinsic) muscles
. Deep muscles (Intrinsic): The rotator cuff tendons attach to the deep rotator cuff muscles.
These 4 muscles are involved in raising the arm from the side androtating the shoulder in the many directions. The rotator cuff
mechanism also helps keep the shoulder joint stable by holding thehumeral head in the glenoid socket. These muscles are:subscapularis, supraspinatus, infraspinatus and teres minor.
3. Back Muscles (Posterior): These muscles are at the back of the shoulder that stabilise and
move the scapula on the trunk of the body. This group includes the
trapezius, rhomboids, levator scapulae, and the serratus anteriormuscles; and are concerned with stabilisation and rotation of thescapula.
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Bursas of the Shoulder
Sandwiched between the rotator cuffmuscles and the outer layer of large bulkymuscles is a structure known as a bursa.Bursae are everywhere in the body. Theyare found wherever two body parts moveagainst one another and there is no joint toreduce the friction. A bursa is simply a sacbetween two moving surfaces that containsa small amount of lubricating fluid.
Think of a bursa like this: If you press yourhands together and slide them against oneanother, you produce some friction. In fact,when your hands are cold you may rubthem together briskly to create heat fromthe friction. Now imagine that you hold inyour hands a small plastic sack that contains
a few drops of salad oil. This sack would letyour hands glide freely against each otherwithout a great deal of friction.
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Break
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Muscles of the Back
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Superficial muscles
Muscle Origin Insertion Action NerveTrapezius Occiput,
nuchal lineClavicle,acromion,
spine ofscapula
Rotator,adductor,
lowers thescapula.
Spinalaccessory
nerve
Latissimusdorsi
Thoraco-Lumbar
fascia,spines of lumbar& sacral,iliac crest,lower 4 ribs
Intertubercular groove
or bicipitalgroove.
Extends,adducts,
medianrotator ofshoulder
Thoraco
dorsal ( long
subscapular)
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Superficial, rhomboid layerMuscle Origin Insertion Action NerveLevatorscapula
Post,tubercle andtransverse
processC1-4
Medialborderscapula,
higher
Elevator androtator ofscapula
Dorsalscapularnerve
Rhomboidminor
Nuchal lig.Spine C7-T1
Medialborderscapula,
lower
Adductscapulamedially,
depressor ofscapula
Dorsalscapularnerve
Rhomboidmajor
Spine T2T5,supraspinous
lig.
Medialborder lower
Adductscapulamedially,
depressor
Dorsalscapularnerve
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Deep muscles of the back,
transverse- costal group Splenius capitisfrom nuchal lig, spine of C7, T1-3 to occiput ,
mastoid
Splenius cervicisspines of T3-6 to transverse process C1-3
Erector spinaemed crest of scarum to lower 6 ribs
Iliocostalis lumborumfrom spines T11 L5, iliac crest to sacrum
Iliocostalis thoracis- from lower 6 rib angle to rib 1-6/trnsvrs proc.C7
Iliocostalis cervicis- angle rib 3-6 to trnsvrs poc. C4-6
Longissimus thoracis- mid crest sacrum
Longissimus cervicis- transvrs proc T1 - 5
Longissimus capitis- transvrs proc. T1- 5, artic. Proc C5 - 7
Spinalis thoracis- spines T11 L2
Spinalis cervicis- C7 to spine C2
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Deep layer, Transverse-spinal group
Semispinalis thoracistransvrs proc. T6 -10 to spines C6-T4
Semispinalis cervicistransvrs proc. T1-T6, to spines C2-C5
Semispinalis capitisTransvrs proc. C7-T7, to nuchal plane of occiput
Spinalis capitis- transvrs proc. C7-T7, to nuchal plane occiput Multifidus
Sacralpost sacrum to spines o C2L5
Lumbarmamillary proc.
Thoracicfrom transvrs process
Cervicalfrom articular proc C4C7
Rotatores Longitransvrs proc of 1 vertebra to spine 2 vertebra above
Brevestransvrs proc of 1 vertebra to next vertebra above
Interspinalisconnects apices of spines of adjoining vertebra
Intertransverse- interconnects anterior tubercle of transvrs process
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Actions, general.
Nerve supply by all posterior primary divisions of spinal nerves.
Spleniusdraws head back, bends head laterally, rotates ace tosame side.
Iliocostalis- bends vertebral column to side, lumborum depress ribs Longissimus thoracis and cervicis bends column to side, depress ribs
Longissimus capitis extends head, bends head to side, rotates face tosame side
Semispinalis thoracis & cervicis- rotates column to same side.
Semispinalis capitis extends head rotates head to opposite side. Multifidus rotates column to opposite side.
Rotatores rotates column to opposite side.
Intertransverse bends column to same side.
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Thank you