Brachial Plexus Dr. Mohammed Hussein - PowerPoint Presentation

1. Brachial Plexus Dr. Mohammed HusseinMBChB – MSc – PhD – MRCPCH – DCH (UK)

2. Nerve plexusesNerve plexuses are combined nerve fibers from different sources or levels to form new nerves with specific targets or destinations. Nerve plexuses are either somatic or visceral.

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4. Brachial PlexusThe brachial plexus is a somatic nerve plexus formed by:The anterior rami of C5 to C8Most of the anterior ramus of T1

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6. The plexus originates in the neck, passes laterally and inferiorly over rib I, and enters the axillaBrachial Plexus

7. Brachial PlexusProximal parts of the brachial plexus are posterior to the subclavian artery in the neck.While more distal regions of the plexus surround the axillary artery.Subclavian artery Axillary artery

8. The parts of the brachial plexus, from medial to lateral, are:RootsTrunksDivisionsCordsBranches+÷+÷

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10. T1C8C7C6C5Roots Trunks Anterior rami of spinal nerves C5-T1 Divisions Cords Terminal branches CICIICIVCIIICVCVICVIITI

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12. C5C6C7C8T1SuperiorMiddleInferiorDivisions Anterior Posterior Anterior posteriorPosterior Anterior TrunkCords Lateral Posterior Medial Roots Terminal Branches

13. T1C8C7C6C5Subclavian A. Middle scalene Anterior scalene Roots

14. TrunksThe three trunks of the brachial plexus originate from the roots, pass laterally over rib I, and enter the axilla. The Superior (Upper) Trunk The Middle Trunk The Inferior (Lower) Trunk Union of C5 and C6 rootsContinuation of the C7 rootUnion of the C8 and T1 rootsT1C8C7C6C5is formed byis ais formed by

15. DivisionsEach of the three trunks of the brachial plexus divides into an anterior and a posterior division: The three posterior divisions combine to form parts of the brachial plexus that give rise to nerves associated with the posterior compartments of the arm and forearm. The three anterior divisions form parts of the brachial plexus that ultimately give rise to peripheral nerves associated with the anterior compartments of the arm and forearm.No peripheral nerves originate directly from the divisions of the brachial plexus.

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17. The TrunksThe Divisions

18. CordsThe three cords of the brachial plexus originate from the divisionsThe posterior cord is formed by the union of all posterior divisionsThe lateral cord is the union of the anterior divisions of superior and middle trunksThe medial cord is the direct continuation of the anterior division of inferior trunk

19. The DivisionsPosterior cordLateral cordMedial cordThe cords are related to the 2nd part of the axillary artery. The lateral cord is lateral to the artery.The medial cord is medial to the artery.The posterior cord is posterior to the artery.Sup. TrunkInf. TrunkM. Trunk

20. Generally: Nerves associated with the anterior compartments of the upper limb arise from the medial and lateral cordsNerves associated with the posterior compartments of the upper limb arise from the posterior cord

21. BranchesGenerally there are 16 branches2 from the Roots2 from the Superior Trunk0 from the Divisions12 from the Cords 3 form the lateral cord 5 from the medial cord 5 from the posterior cord

22. 2 2 0 12 3 5 5

23. Branches of Roots2 Branches2. Long thoracic N.1. Dorsal scapular N.

24. C1C2C3C4C5C6C7T1T2Dorsal scapular nerve

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26. C1C2C3C4C5C6C7T1T2Long thoracic nerve

27. Branches of Superior Trunk 2 Branches1. Suprascapular N.2. Nerve to Subclavius

28. Suprascapular nerveSuperior trunk

29. Suprascapular nerveSuprascapular foramenSupraspinatus and infraspinatus muscles

30. Nerve to subclaviusSuperior trunk

31. Branches of Lateral Cord1. Lateral pectoral N.2. Musculocutaneous N.3. The lateral root of median N.3 Branches

32. Lateral pectoral nerveMusculocutaneous nerveLateral root of median nerveBranches of lateral cordLateral pectoral nerveMusculocutaneous nerveLateral root of median nerveMedian nerve

33. Branches of Medial Cord1. Medial pectoral N.2. Medial Cut. N. of arm3. Medial Cut. N. of forearm5. Ulnar N.4. The medial root of median N.5 Branches

34. Branches of medial cordMedial pectoral nerveMedial cutaneous nerve of armMedial cutaneous nerve of forearmMedial root of median nerveUlnar nerveMedial pectoral nerveMedial cutaneous nerve of armMedial cutaneous nerve of forearmMedial root of median nerveUlnar nerveMedian nerve

35. Branches of Posterior Cord5. Inferior Subscapular N.1. Superior Subscapular N. 2. Thoracodorsal N. 3. Axillary N. 4. Radial N.5 BranchesSTARS

36. Branches of posterior cordSuperior Subscapular nerveThoracodorsal nerve Axillary nerveRadial nerveInferior Subscapular nerveSubscapularisLatissimus Teres major Triceps

37. Branches of posterior cordSuperior Subscapular nerveThoracodorsal nerve Axillary nerveRadial nerveInferior Subscapular nerveSuperior subscapular nerveInferior subscapular nerveThoracodorsal nerve Axillary nerve Radial nervePosterior cutaneous nerve of arm

38. Branches of the roots Branch nameDorsal scapularOrigin C5 rootRoot value(Spinal segment)C5Function Motor: Rhomboid major, Rhomboid minor, Levator scapulae

39. Branches of the roots Branch nameLong thoracicOrigin C5 to C7 rootsRoot value(Spinal segment)C5 to C7Function Motor: Serratus anterior

40. Branches of the superior trunk Branch nameSuprascapularOrigin Superior trunkRoot value(Spinal segment)C5, C6Function Motor: Supraspinatus, infraspinatus

41. Branches of the superior trunk Branch nameNerve to subclaviusOrigin Superior trunkRoot value(Spinal segment)C5, C6Function Motor: Subclavius

42. Branches of the lateral cordBranch nameLateral pectoralOrigin Lateral cordRoot value(Spinal segment)C5 to C7Function Motor: Pectoralis major

43. Branches of the lateral cordBranch nameMusculocutaneousOrigin Lateral cordRoot value(Spinal segment)C5 to C7Function Motor: All muscles in the anterior compartment of the armSensory: Skin on lateral side of forearm

44. Branches of the medial cordBranch nameMedial pectoralOrigin Medial cordRoot value(Spinal segment)C8, T1Function Motor: Pectoralis major, pectoralis minor

45. Branches of the medial cordBranch nameMedial cutaneous nerve of armOrigin Medial cordRoot value(Spinal segment)C8, T1Function Sensory: Skin on medial side of distal one-third of arm

46. Branches of the medial cordBranch nameMedial cutaneous nerve of forearmOrigin Medial cordRoot value(Spinal segment)C8, T1Function Sensory: Skin on medial side of side of forearm

47. Branches of the medial cordBranch nameUlnarOrigin Medial cordRoot value(Spinal segment)C8, T1Function Motor: All intrinsic muscles of the hand (except three thenar muscles and two lateral lumbricals) and FCU and medial ½ of FDPSensory: medial 1 ½ fingers

48. The median nerveBranch nameMedian nerveOrigin Medial and lateral cordsRoot value(Spinal segment)(C5), C6 to T1Function Motor: All muscles in the anterior compartment of the forearm (except 1 & 1/2 muscles) and thenar and lateral 2 lumbricals Sensory: lateral 3 ½ fingers

49. Branches of the posterior cordBranch nameSuperior subscapularOrigin Posterior cordRoot value(Spinal segment)C5, C6Function Motor: Subscapularis

50. Branches of the posterior cordBranch nameInferior subscapularOrigin Posterior cordRoot value(Spinal segment)C5, C6Function Motor: Subscapularis, teres major

51. Branches of the posterior cordBranch nameAxillaryOrigin Posterior cordRoot value(Spinal segment)C5, C6Function Motor: Deltoid, teres minorSensory: Skin over upper lateral part of arm

52. Branches of the posterior cordBranch nameThoracodorsalOrigin Posterior cordRoot value(Spinal segment)C6 to C8Function Motor: Latissimus dorsi

53. Branches of the posterior cordBranch nameRadialOrigin Posterior cordRoot value(Spinal segment)C5 to C8, (T1)Function Motor: All muscles in the posterior compartments of arm and forearmSensory: Skin on the posterior aspects of the arm and forearm, the lower lateral surface of the arm, and the dorsal lateral surface of the hand

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