Brachial Plexus - Julie Cornish
-
Upload
welshbarbers -
Category
Health & Medicine
-
view
264 -
download
5
Transcript of Brachial Plexus - Julie Cornish
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