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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.

    http://en.wikipedia.org/wiki/Scapulahttp://en.wikipedia.org/wiki/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