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Anatomy II > Brachial Overview > Flashcards

Brachial Overview Flashcards

1
Q

Brachial Plexus is formed by what nerves?

A

C5-T1

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2
Q

5 divisions of the brachial plexus

A

Roots
Trunks
Divisions
Cords
Branches or Terminal Nerves

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3
Q

Lance’s mnemonic for the brachial plexus

A

Randy Travis Drinks Cold Beer

Proximal to distal

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4
Q

Dermatomes for anterior arm

A

C5-T1 covers everything except upper medial aspect. “think inside the bicep”

T2 covers the rest

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5
Q

Dermatomes for shoulder and lateral arm

A

C5-C7

Axillary nerve covers the deltoid portion of the shoulder

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6
Q

Dermatomes for medial arm and hand

Ulnar nerve

A

C8-T1

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7
Q

Arm innervation

A
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8
Q

Medial Arm Innervation

A
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9
Q

Hand Innervation

A
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10
Q

4 brachial plexus blocks

A
  1. Interscalene
  2. Supraclavicular
  3. Infraclavicular
  4. Axillary
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11
Q

Which brachial plexus block covers the entire arm?

A

None

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12
Q

Interscalene

Blocks “Roots” or Randy

A

Blocks C5-C7
Does NOT block C8-T1

This is an ulnar nerve sparring block (medial elbow and forearm)

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13
Q

What surgeries are the interscalene good and bad for?

A

Good:
Shoulder and upper arm
Bad:
forearm, elbow, and hand

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14
Q

Disadvantages to interscalene block?

3

A
  1. ipsilateral hemidiaphragmatic paresis
  2. hoarseness
  3. Horner’s Syndrome
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15
Q

What is Horner’s Syndrome?

A

Miosis: pupil constriction
Ptosis: upper eyelid droop
Anhidrosis: makes little to no sweat

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16
Q

The Supraclavicular and Infraclavicular block does the same thing, what are the differences?

A
  • Supra block is at the Trunks and Divisons level
  • Infra block is at the Cords level
  • Infra not indicated for shoulder surgery because of the more distal needle insertion site
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17
Q

Supra/infraclacivular blocks what nerves?

A

C5-T1

Does not cover T2

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18
Q

Is the supraclacivular block indicated for shoulder surgery?

A

Not really, it works but not as well as the interscalene

less effective spread to the suprascapular and axillary nerves than the interscalene block

19
Q

Why do we still use the supraclavicular block for shoulder surgery then?

A

Avoids interscalene complications like paralyzing half of the diaphram

20
Q

Axillary nerve block

A

Blocks the hand but not the upper arm
Can only block the entire forearm/elbow with a supplemental musculocutaneous block

21
Q

Axillary block, which nerves?

A

At the Branches level:
Median
Radial
Ulnar

Musculocutaneous sparring

22
Q

Where does the musculocutaneous nerve innervate?

A

lateral forearm only

23
Q

Do we need to a supplemental musculocutanseous block for hand surgery?

A

No, it only innervates the lateral forearm so an axillary block would be suffcient

24
Q

Do we need to a suplemental musculotanseous block for forearm surgery?

A

Yes, it innervates the lateral forearm so an axillary block would not be suffcient

25
Q

Anatomically what does the musculocutaneous nerve do in the axilla?

A

It diverges away from the Median, Radial, and Ulnar neurovascular bundle

This is why it is missed when preforming the axillary block

26
Q

What is strange about the axillary block and the axillary nerve

A

It is not blocked by the axillary nerve block because the axillary nerve is on the cords level and the axillary block is on the branches level

Since the axillary nerve innervates the upper arm/shoulder this is not a good block for shoulder surgery

27
Q

During hand surgery that uses a tourniquet what block/s need to be done?

A

Axillary and Musculocutaneous

28
Q

What is the supplemental T2 block called?

A

Intercostobrachial Block

29
Q

What does the T2 Intercostobrachial block cover?

A

Upper medial arm (what the brachial plexus does not innervate)

30
Q

What is the T2 block indicated for?

A

Axillary surgery and medial elbow surgery

31
Q

Does the T2 block help with tourniquet pain?

A

Nope

32
Q

Where is the T2 Intercostobrachial block performed?

A

Axillary region (think medial)
Upper boarder of the bicep
lower border of the tricpes

33
Q

What does the Medial Cutaneous block cover?

A

C8-T1

AKA Ulnar nerve block

34
Q

What block is the medial cutaneous added to?

A

Interscalene

35
Q

What blocks are indicated for forearm surgery?

A

Axillary + Musculocutaneous
or
Supra/Infraclavicular

36
Q

What block is indicated for shoulder surgery?

A

Interscalene

Maybe Supraclavivular is some parts of the country

37
Q

What block is indicated in hand surgery?

A
  1. Axillary (lower risk for complications)
  2. Supra/Infraclavicular
38
Q

Possible Complications: Interscalene

HIRE-VUU

A

Horner’s Syndrome
Ipsilateral phrenic nerve palsy
RLN palsy and hoarseness
Epidural/subarachnoid injection
Vertebral Artery puncture
Ulnar sparring
Upper arm T/Q pain (T1&T2)

39
Q

Possible Complications: Supraclavicular

SIR-HUP

A

Subclavian artery puncture
Ipsilateral phrenic nerve palsy (less common)
RLN palsy and hoarsness (less common)
Horner’s Syndrome (less common)
Upper arm T/Q pain (T2)
Pneumothorax (highest risk)

40
Q

Possible Complications: Infraclavicular

PAU

A

Pneumothorax
Axillary artery puncture
Upper arm T/Q pain (T2)

41
Q

Possible Complications: Axillary

SAU

A

Spares musculocutaneous
Axillary artery puncture
Upper arm T/Q pain (T2)

42
Q

Contraindications: Interscalene

A

Respiratory Dx/COPD
Contralateral phrenic nerve dysfunction

43
Q

Contraindications: Supraclavicular

A

Respiratory Dx/COPD
Contralateral phrenic nerve dysfunction

44
Q

Contraindications: Infraclavicular

A

Ipsilateral cental line or pacemaker

Best for COPD patients

Anatomy II (10 decks)

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