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Anatomical sciences > Brachial plexus > Flashcards

Brachial plexus Flashcards

1
Q

outline the various components of the brachial plexus

A

roots
trunks
divisions
cords
branches

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2
Q

what are the spinal nerves part of

A

the peripheral nerve system

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3
Q

how many pairs of spinal nerves

A

31 pairs

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4
Q

where of spinal nerves arise from

A

dorsal and ventral roots

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5
Q

what fibres are from the dorsal root

A

afferent sensory fibres (body -> brain)

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6
Q

what fibres are from the ventral root

A

efferent motor fibres (brain -> muscle)

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7
Q

what do dorsal and ventral roots merge into

A

single spinal nerve
containing sensory and motor fibres (mixed nerve)

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8
Q

what do the spinal nerves exit via

A

intervertebral foramen

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9
Q

what does the intervertebral formed divide into

A

dorsal / posterior ramus
venture / anterior ramus

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10
Q

what forms a plexus

A

some rami (ramus) from different spinal nerves will anastomose into a plexus ( e.g brachial plexus )

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11
Q

what is a plexus

A

a network of intersecting nerves or vessels (arteries)

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12
Q

what is a nerve plexus

A

a network of intersecting nerve fibres from different spinal nerves that serve the sam part of the body
terminate distally as individual nerves

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13
Q

what spinal nerves form brachial plexus

A

Anterior rami
spinal nerve C5 -T1

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14
Q

what are dermatomes

A

an area of skin in which sensory peripheral nerves derive from a single spinal nerve root
each spinal nerve relays sensation form a particular region of the skin to the brain

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15
Q

cervical nerves

A

C1-C8
carry sensation from cevical dermatomes (C2-C8)
head neck majority of arm and hand

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16
Q

how come there are only 30 dermatomes but 31 pairs of spinal nerves

A

C1 spinal nerve does not have a dorsal root so does not carry sensory information from the skin

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17
Q

thoracic nerves

A

T1-T12
carry sensation from thoracic dermatomes
(torso , inner part of arm )

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18
Q

lumbar nerves

A

L1-L5
carry sensation from lumbar dermatomes
(groin area, majority of lower limbs)

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19
Q

sacral nerves

A

S1-S5
carry sensation from sacral dermatomes
(minority of lower limbs, perianal region, genitals)

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20
Q

coccygeal nerve

A

C0
Carry sensation from coccyx (Co1)
(coccygeal region - around the tailbone)

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21
Q

what are myotomes

A

muscle innervated by a single spinal nerve
each spinal nerve relays motor information to a particular set of muscles
most muscle = more than one myotomes - receive innervation from more than one spinal nerve

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22
Q

brachial plexus

A

a complex intercommunicating network of nerves
provides sensory and motor innervation to upper extremity

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23
Q

areas supplied by branchial plexus - Sensory innervation

A

upper limb except area of the skin near the axilla

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24
Q

areas supplied by branchial plexus - motor innervation

A

muscles of upper limb
should girdle except trapezius muscle

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25
Q

roots

A

C5, C6, C7, C8, T1

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26
Q

trunks

A

superior
middle
inferior

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27
Q

divisions

A

anterior or posterior

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28
Q

cords

A

material
posterior
medial

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29
Q

terminal branches

A

musculocutaneous nerve
axillary nerve
radial nerve
median nerve
ulnar nerve

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30
Q

where do the roots of brachial plexus emerge

A

anterior rami C5-T1 spinal nerves emerge from respective interveteral foramen

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31
Q

where do the roots of brachial plexus lie

A

lie in posterior triangle of the neck between anterior and medial scalene muscles

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32
Q

when do roots unite to form trunks

A

shortly after exiting foramen the roots -> trunks

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33
Q

what part of the trunk do the C5 and C6 roots form

A

superior upper trunk

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34
Q

what part of the trunk does the C7 root form

A

middle trunk

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35
Q

what part of the trunk does the C8 and T1 roots form

A

inferior lower trunk

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36
Q

what muscles does the trunk of brachial plexus pass through

A

anterior and medial scalene muscles

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37
Q

where is trunk of brachial plexus

A

cross base of posterior triangle of the neck
passes over apex of lung and first rib towards clavicle

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38
Q

what and where does the trunk divide

A

at posterior aspect of the middle third of the clavicle trunks split into divisions

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39
Q

how many anterior and posterior divisions are there

A

3 anterior (superior, middle and inferior trunks)
3 posterior (superior, middle and inferior trunks)

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40
Q

where do the divisions pass

A

both divisions pass inferiorly behind clavicle
enter axilla and combine to form cords

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41
Q

3 cords

A

lateral cord
posterior ord
medial cord

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42
Q

lateral cord

A

anterior divisions from superior and middle trunks
contain fibres from C5, C6,C7

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43
Q

posterior cord

A

3 posterior divisions
contain fibres from C5 C6 C8 C8 T1

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44
Q

medial cord

A

anterior division from inferior trunk
contain fibres from C8 T1

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45
Q

first part of axillary artery

A

posterior and lateral cords - super-lateral to artery
medial cord = posterior to artery

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46
Q

second part of axillary artery

A

posterior cord = posterior to artery
medial cord = medial to artery
lateral cord = lateral to artery

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47
Q

3rd part of axillary artery

A

cords terminate by elongating into 5 terminal branches

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48
Q

terminal branches of lateral cord

A

musculocutaneous nerve
lateral root of median nerve

49
Q

terminal branches of posterior cord

A

redial nerve
axillary nerve

50
Q

terminal branches of medial cord

A

ulnar nerve
medial root of median nerve

51
Q

pre sized brachial plexus

A

plexus is derived from C4-C8

52
Q

post fixed brachial plexus

A

plexus is derived from C6-T2

53
Q

where do pre terminal nerves arise from

A

roots trunks and cords of the plexus

54
Q

where does long thoracic nerve originate from

A

C5, C6, C7
Innervates the serratus anterior muscle

55
Q

flexion

A

decrease angle between 2 body parts

56
Q

extension

A

increase angle between 2 body parts

57
Q

abduction

A

away form midline

58
Q

adduction

A

towards midline

59
Q

supination

A

palm up

60
Q

pronation

A

palm down

61
Q

route of musculocutaneous nerve

A

formed in axilla
passes down flexor compartment of the arm
eerges lateral to biceps tendon
continues into forearm as lateral cutaneous nerve

62
Q

musculoctaneous nerve = sensory (arm)

A

sensory information
lateral half of anterior forearm
small lateral part of posterior forearm

63
Q

musculoctaneous nerve motor (arm)

A

biceps brachii - flexion of arm and forearm
coracobrachialis - flexion of arm
brachial - flexion of forearm
and forearm supination

64
Q

What happens if musculoctaneous nerve is damaged

A

affect ..
sensation of innervated skin
flexion at shoulder and elbow
supination of forearm

65
Q

route of axillary nerve

A

Ford in axilla
exits axilla at inferior border of subscapularis muscle
divides into 3 terminal branches at surgical neck of humerus
- anterior terminal branch
- posterior terminal branch
- articular branch

66
Q

axillary nerve sensory function

A

provides sensory information from
inferior lateral deltoid region ( regimental badge area)

67
Q

axillary nerve motor function

A

innervates
teres minor - later / eternal rotation of arm
deltoid - arm abduction (15 degrees onward )

68
Q

what happens if the axillary nerve is damaged

A

sensation of innervated skin
arm abduction from 15 degrees onwards

69
Q

route of median nerve

A

Axilla -> descends down arm alongside brachial artery (laterally then medially halfway down arm ) -> enters forearm at cubital fossa -> travels down forearm -> gives of 2 main branches en route through forearm -> enter hand via carpal tunnel -> 2 terminal branches in the hand

70
Q

sensory function of median nerve

A

Proximal part of palm
Palmar surface and fingertips of lateral 3 ½ digits

71
Q

motor function of median nerve

A

Innervates
Majority of muscle in anterior forearm
Remaining 2 muscles supplied by ulnar nerve
Thenar muscles (movements of the thumb)
Lateral 2 lumbrical muscles (flexion at metacarpophalangeal joints and extension at interphalangeal joints of the index and middle fingers)

72
Q

damage at elbow - medial nerve

A

Damage at elbow
cubital fossa
Lack of sensation over palmer surface and fingertips of lateral 31/2 digits
Weakness of pronation of forearm and wrist flexion
Weakness in flexion of index and middle fingers
Weakness in thumb flexion

73
Q

damage at wrist - medial nerve

A

Damage at wrist
Lack of sensation over distal palmer surface and fingertips of lateral 31/2 digits
Weakness in flexion of index and middle fingers
Weakness in thumb flexion

74
Q

route of radial nerve

A

Axilla -> exits axilla and travels in radial /spiral groove of humerus -> travels on the lateral part of the elbow through cubital fossa -> enters the forearm and terminated by dividing into 2 branches

75
Q

sensory function of radial nerve

A

Arm branches prior to radial groove
Posterior surface of the arm
Arm branches coming off in groove
Lateral surface of arm
strip of skin down middle of posterior forearm
Terminal branches
dorsal surface of lateral 31/2 digits (not fingertips) + associated area on dorsum of hand

76
Q

motor function of radial nerve

A

Innervates
Branches in arm (triceps brachii – extends arm at elbow)
Terminal branches ( muscles in posterior compartment of forearm – extend at the wrist and finger joints and supinate the forearm)

77
Q

damage at arm - radial nerve

A

Damage at arm (spiral groove)
Lack of sensation in lateral and posterior arm , posterior forearm , dorsal surface of later 31/2 digits and associated area of dorsum of hand
inability to extend at forearm , extend at wrist and fingers
Wrist drop = as wrist flexors are unopposed

78
Q

damage at forearm - radial nerve

A

Damage at forearm
Lack of sensation on dorsal surface of the lateral 31/2 digits and associated area of dorsum of hand
Weakness in extension at wrist and fingers
NO wrist drop

79
Q

route of ulnar nerve

A

Axilla -> Exits axilla and descends down the arm -> Mid way down the arm it enters posterior compartment of the arm -> travels posterior to the elbow through cubital (ulnar) tunnel -> travels alongside ulna in forearm + gives of 3 main branches -> enters hand via ulnar canal (guyons canal) -> terminates in superficial and deep branches

80
Q

sensory functions of ulnar nerve

A

Sensory information
Medial 11/2 fingers and the associate dorsal and palmar area of hand

81
Q

motor function of ulnar nerve

A

Sensory information
Medial 11/2 fingers and the associate dorsal and palmar area of hand
Innervates
2 muscle of forearm – flexes and adducts hand at wrist
The major of the intrinsic hand muscles - abduction and adduction of fingers – movement of 4th and 5th digits – thumb adduction

82
Q

damage at elbow ulnar nerve

A

Damage at elbow
Less clawing
Affects all the sensory and motor branches of the ulnar nerve results in –
Loss of sensation in medial 1 ½ digits and the associated dorsal and palmar area of hand
Impaired ability to flex and adduct wrist
Impaired movement of the 4th and 5th digits and thumb adduction
Loss of abduction and adduction of the fingers

83
Q

damage at wrist ulnar nerve

A

Damage at wrist
More clawing
Loss of sensation over palmar side of medial 11/2 digits and distal palm area
Only the intrinsic muscle of the hand are affected
Impaired movement of the 4th and 5th digits and thumb adduction
Loss of abduction and adduction of the finger
Hyper extension of the 4th and 5th metacarpophalangeal joints and flexion at the interphalangeal
More prominent in distal (wrist) as opposed to proximal (elbow) ulnar nerve damage

84
Q

what is the test for ulnar nerve damage

A

forments sign test
* patient asked to grip a piece of paper between thumb and index finger
* positive front sign= patient hyper flexes thumb and can’t grip paper = ulnar nerve damage

85
Q

cubital fossa

A

elbow pit - a small triangular area located on the anterior surface of the elbow

85
Q

cubital fossa

A

elbow pit - a small triangular area located on the anterior surface of the elbow

86
Q

Why is there wrist drop in radial nerve damage at the axilla and the arm but not the forearm?

A

because damage to the radial nerve that occurs before the forearm will result in wrist drop, but the muscles innervation branches off prior to the forearm , so that muscle maintains extension at the wrist

87
Q

Why are only the intrinsic muscles of the hand affected by ulnar nerve damage at the wrist?

A

because the 2 forearm muscles supplied by the ulnar nerve are not affected because their branches come off before the wrist.

88
Q

what is claw hand

A

hyperextension of the 4th and 5th metacaropophalageal joints and flexion at the interphalageal

89
Q

What type of ulnar damage gives rise to more prominent claw hand?

A

more prominent in distal distal (wrist) as opposed to proximal (elbow) ulnar nerve damage

90
Q

what are the types of brachial plexus injuries

A

avulsion, rupture, stretching, compression

91
Q

common symptoms of brachial plexus injury

A
  • reduced/absent sensation in arm or Hand
  • weakness/paralysis of shoulder, arm, wrist or hand
  • mild severe pain in shoulder or arm
92
Q

treatment of a brachial plexus injury

A
  • may resolve
  • non surgical - physiotherapy steroid
  • surgery - nere repair/ graft/ transfer
93
Q

What nerves are damages in Erbs palsy and what does this cause

A

to injury of C5-C6
Paralysis of upper brachial plexus

94
Q

what is Erbs Palsy caused by

A

Excessive increase in angle between neck and shoulder due to trauma or birth

95
Q

what nerves are affected due to Erbs palsy

A

Axillary
Impact musclocutaneous, radial and median

96
Q

what motor (myotomes) are affects by Erbs palsy

A

C5 and C6 myotomes

97
Q

what sensory (dermatomes) are affected by Erbs palsy

A

C5 and C6 dermatomes

98
Q

what are the symptoms / signs of Erbs Palsy

A

Arm extended and wrist fully flexed (waiters tip)

99
Q

what part of brachial plexus is damaged in Klumpke palsy

A

Paralysis of upper brachial plexus due to injury to C8-T1

100
Q

what can cause Klempke palsy

A

Hyper abduction of arm (trauma)
birth

101
Q

what is more common at birth Erbs or Klumke palsy

A

Erbs palsy is more common at birth

102
Q

what nerves are affected by klumpkes palsy

A

Ulnar
Radial and median

103
Q

what causes carpal tunnel syndrome

A

compression of the median nerve within the carpal tunnel

104
Q

what risk factors cause carpal tunnel syndrome

A

repetivitive weist movement
obesity
autoimmune disease

105
Q

what are the sensory clinical features of carpal tunnel syndrome

A

numbness
tingling
pain in distribution of skin supplied by distal median nerve
distal palmer surface and fingertips of lateral 3 1/2 digits

106
Q

what are the motor clinical features of carpal tunnel syndrome

A

weakness of first and second lumbricals and thenar muscles
weakness in flexion of index and middle finger and thumb

107
Q

what can cause humeral shaft fracture and radial nerve damage

A

fractured of shaft often from trauma

108
Q

why is the radial nerve at increased risk of damage

A

as radial nerve travels through radial groove
increase risk of damage

109
Q

what are the sensory clinical features of humeral shaft fracture/radial nerve damage

A

numbness, tingling pain in distribution of skin supplied by radial nerve
dorsal surface of lateral 31/2 digits and associated area on dorm of hand
sensory loss of forearm

110
Q

what are the motor clinical features of humeral shaft fracture/ radial nerve damage

A

weakness of muscles in posterior forearm
weakness in forearm extension
unable to extend at wrist and fingers
wrist drop

111
Q

what nerve is most likely to be damages if a fracture is at the proximal humerus / scapula such as a (glenohumeral dislocation)

A

axillary nerves (glenohumeral dislocation)

112
Q

what is th most common cause of axillary damage

A

(glenohumeral dislocation)

113
Q

what nerve is most likely to be damages if a fracture is at supracondylar

A

median nerve
the radial nerve
rare= ulnar nerve

114
Q

what nerve can be compressed in cubital tunnel syndrome

A

ulnar nerve
= ulnar neuropathy

115
Q

what are the risk factors of capital tunnel syndrome/ulnar neuropathy

A

prolonged elbox flexion
leaning on elbows

116
Q

what are the sensory clinical features of cubital tunnel syndrome/ulnar neuropathy

A

numbness tingling pain in distribution of skin supplied by ulnar nerve
medial 11/2 digits and associated area on palm of hand

117
Q

what are the motor clinical features of cubital tunnel syndrome/ulnar neuropathy

A

weakness of 2 muscle of forearm and majority of intrinsic hand muscle
loss of abduction and adduction of fingers
weakness of movement of 4th and 5th digits and thumb adduction
minimal ulnar claw

Anatomical sciences (12 decks)

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