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brachial plexus Flashcards

1
Q

bachial plexus is formed by–

A

anterior rami (divisions) of cervical spinal nerves C5, C6, C7 and C8, and C8, and the first thoracic spinal nerve, T1

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2
Q

bachial plexus is structurally organized into______

A

roots→ trunks→ divisions→ cords→ branches

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3
Q

Cutaneous branches of the Brachial plexus include

A

i. Medial brachial cutaneous nerve (Medial cutaneous nerve of arm, branch of Ulnar nerve/ Medial cord)

ii. Medial antebrachial cutaneous nerve (Medial cutaneous nerve of forearm, branch of Ulnar nerve/ Medial cord)

iii. Posterior brachial cutaneous nerve (Posterior cutaneous nerve of arm, branch of Radial nerve)

iv. Posterior antebrachial cutaneous nerve (Posterior cutaneous nerve of forearm, branch of Radial nerve)

v. Inferolateral brachial cutaneous nerve (Inferior lateral cutaneous nerve of arm, branch of Radial nerve)

v. Superolateral brachial cutaneous nerve (Superior lateral cutaneous nerve of arm, branch of Axillary nerve)

vii. Lateral antebrachial nerve (Lateral cutaneous nerve of forearm, branch of Musculocutaneous nerve)

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4
Q

medial cord and ulnar nerve give rise to what cutaneous branches

A

i. Medial brachial cutaneous nerve (Medial cutaneous nerve of arm, branch of Ulnar nerve/ Medial cord)

ii. Medial antebrachial cutaneous nerve (Medial cutaneous nerve of forearm, branch of Ulnar nerve/ Medial cord)

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5
Q

the brach of the radial nerve give rise to which cutaneous branches

A

iii. Posterior brachial cutaneous nerve (Posterior cutaneous nerve of arm, branch of Radial nerve)

iv. Posterior antebrachial cutaneous nerve (Posterior cutaneous nerve of forearm, branch of Radial nerve)

v. Inferolateral brachial cutaneous nerve (Inferior lateral cutaneous nerve of arm, branch of Radial nerve)

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6
Q

axillary nerve gives rise to_____cutaneous branch

A

Superolateral brachial cutaneous nerve- arm

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7
Q

branch of Musculocutaneous nerve gives rise to _______ cutaneous branch

A

Lateral antebrachial nerve (Lateral cutaneous nerve of forearm, branch of Musculocutaneous nerve)

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8
Q

Suprascapular nerve (C____)

innervates

A

Suprascapular nerve (C4, C5, C6):

inervates – Supraspinatus muscle

– Infraspinatus muscle

Glenohumeral (shoulder) joint

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9
Q

Dorsal scapular nerve (C___):

A

Dorsal scapular nerve (C5):

innervate Rhomboids minor, and Rhomboid major muscles, and occasionally supplies
Levator scapulae muscle

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10
Q

supraclavicular nerves of Brachial Plexus and their roots

A

suprascapular C4-C6)

subclavian nerve (C4-C6)

dorsal scapular nerve (c5)

upper subscapular nerve (C5)

inferior subscapular nerve (C6)

long thoracic nerve ( C5-C7)

*thoracodorsal Nerve (C6-C8)

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11
Q

upper subscapular nerve (C5) vs inferior subscapular nerve (C6) innervations

A

Innervates– Subscapularis (superior portion) muscle– which controls the adduction and medial rotation of arm

Innervates:
I. Subscapularis (inferior portion) muscle– which controls adduction and medial rotation of arm

II. Teres major muscle– whose contraction results in the adduction and medial rotation of arm

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12
Q

Subclavian nerve (Nerve to subclavius, C4, C5 and C6):

A
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13
Q

Long Thoracic nerve (C___):

innervates

A

(C5 to C7)

Innervates– Serratus anterior muscle– whose contraction causes protraction of scapula, and it assists in upward rotation of scapula bone, stabilizes scapula

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14
Q

Lateral pectoral nerve (C___):

communites with_____

innervates____

what joints does it innervate

A

C5 to C7)

pierces costocoracoid membrane to reach the deep surface of Pectoral muscles, a communicating branch to Medial Pectoral nerve passes anterior to axillary vessels

Primarily Pectoralis major muscle– flexion, adduction, and medial rotation of humerus

III. Acromioclavicular and Glenohumeral (shoulder) joints

(sidenote : Suprascapular nerve (C4, C5, C6) innervates glenohumeral joint)

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15
Q

Medial pectoral nerve (C___):

is in between what___

what muscles does it innervate

A
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16
Q

axillary nerve (c __)

important and location

A

C5 and C6

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17
Q

innervation of axillary nerve

and what nerve is give off by the axillary nerve

vulnerable to injury when?

A
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18
Q

musculocutaneous nerve (C____)

what route does it follow?

gives rise to?

A
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19
Q

musculocutaneous nerve (C____)

innervates _____

gives off____ artery

and damage to ____ will lead to

A
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20
Q

median nerve innervates muscle of the______ and _____

A

forearm and hand

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21
Q

median nerve path

what it gives off and it innervates

A

Anterior interosseous branch in the upper part of the forearm, and ends with its innervation of Pronator quadratus

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22
Q

Median nerve innervates the following: (4)

A

I. Pronator teres– pronation of radioulnar joint

II. Flexor carpi radialis– flexion, and adduction of wrist

III. Palmaris longus– flexion of wrist, and tensing of palmar aponeurosis

IV. Flexor digitorum superficialis– flexion of proximal interphalangeal joints of 2nd, 3rd, 4th, and 5th fingers

in mid year, I will pronate and flex in capri where there is long palms and flex my digit! super!

as well as FLexor, Abductor, Opponens pollis of the thumb and 1st and second lumbricals

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23
Q

Flexor muscles of anterior compartment of forearm, including:

A

a. Pronator quadratus– pronation of forearm

b. Flexor digitorum profundus– flexion of wrist at metacarpophalangeal and interphalangeal joints

c. Flexor pollicis longus–flexion of phalanges of the thumb

innervated by median nerve

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24
Q

thenar (palm) group of muscles

A

flexor pillicis breves, abductor pollicis breves, opponens pollicis

FOA pollis breves

innervated by median nerve

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25
Q

1st and 2nd Lumbricals

A

associated with the index and middle fingers

innervated by the median nerve

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26
Q

muscles innervated by median nerve in anterior compartment

A

+ 1st and 2nd lumbricals

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27
Q

wrist and distal radioulnar joints gives off what nerves

A

Palmar cutaneous nerve

II. Palmar digital cutaneous nerve-

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28
Q

carpal tunnel

symptoms

A

compress the median nerve, resulting in a compression neuropathy (Carpal tunnel syndrome)

Carpal tunnel syndrome is characterized by tingling, burning and pain (needle, pin) through the course of median nerve particularly over the outer fingers and radiating up the arm, with weakness in thumb and the first two fingers

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29
Q

Supracondylar fracture damages ______ nerve

A

Supracondylar fracture

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29
Q

draw out brachial plexus

A
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30
Q

hand of benediction

A
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31
Q

what mainly innervates the posterior part of the upper limb?

A

radial nerve

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32
Q

Radial nerve (C5 to C8, and T1):

path and gives of what braches

A
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33
Q

what muscles are innervated by the radial nerve

A

I. Brachioradialis– weak flexor of forearm

II. Triceps brachii– extension of forearm, resist dislocation of shoulder

III. Anconeus– extension of the forearm at elbow joint, stabilizes elbow joint during pronation and supination

IV. Extensor carpi radialis longus– extension and abduction of wrist

V. Elbow, wrist, and radial metacarpophalangeal joints

unco brachi has extensive long tricps and his wrist, elbow and radial metacapophalangeal joints are affected by it

anconeous, brachioradiallis, extesor carpi radialis longus, tricep bracchi

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34
Q

radial nerve Gives off Posterior Interosseous nerve and innervates what muscles

A

I. Extensor carpi radialis brevis– extension and abduction of wrist

II. Supinator– supination of forearm

III. Extensor digitorum– extension of proximal interphalangeal and metacarpophalangeal joints of 2nd, 3rd, 4th, and 5th fingers

IV. Extensor digiti minimi– extension of little finger at interphalangeal and metacarpophalangeal joints

V. Extensor carpi ulnaris– extension and adduction of wrist

VI. Extensor pollicis longus- extension of thumb at carpometacarpal, metacarpophalangeal, and interphalangeal joints

VII. Extensor pollicis brevis– extension of thumb at carpometacarpal, and metacarpophalangeal joints

VIII. Extensor indicis– extension of little finger

IX. Abductor pollicis longus– abduction of thumb at carpometacarpal, and metacarpophalangeal joints

35
Q

radial nerve gives off

A

I. Posterior brachial cutaneous nerve (Posterior cutaneous nerve of arm)

II. Posterior antebrachial cutaneous nerve (Posterior cutaneous nerve of forearm)

IV. Inferiolateral brachial cutaneous nerve (Inferior lateral cutaneous nerve of arm)

f) Radial nerve also gives off Dorsal (digital) cutaneous nerves

posterior interosseous cutaneous nerve

36
Q

damage to radial nerve will lead to

A

wrist drop because wont be able to extend

37
Q

name some radial nerve injuries

A

g) Fracture of mid-shaft or radial groove or lateral epicondyle of Humerus bone,

Improper use of crutches (prolonged compression in axillary region),

person gets drunk on Saturday night and ends up falling asleep on a chair with arm hanging over the back of chair (Saturday night palsy) can cause– Radial nerve injury,

which can lead to:

i. wrist drop (loss of wrist extension due to inability to extend the hand and fingers)

ii. loss of sensory, and motor functions in posterior arm, forearm, and hand

38
Q

In the upper arm, the Median nerve is _______ to Brachial artery and the Ulnar nerve is _______to the brachial artery

______ is a site of compression fro the ulna nerve

A

lateral

medial

canal of guyon

39
Q

ulnar nerve (C8 and T1)

A

descends medial to Brachial artery

passes through back of elbow (medial epicondyle )

40
Q

canal guyon

A
41
Q

what muscles are innervated by the ulnar nerve

A

I. Flexor carpi ulnaris– flexion, and adduction at wrist joint

II. Flexor digitorum profundus (medial/ ulnar half)– flexion of distal interphalangeal joints of 2nd, 3rd, 4th, and 5th fingers

IV. Palmaris brevis– tenses skin of palm on the ulnar side during a grip action

. Most of the Intrinsic muscles of hand (except those in the Thenar group of muscles, and first two lumbricals), and these include:

A. Dorsal Interossei– abduction of 2nd, 3rd, and 4th fingers away from the axial line

B. Palmar Interossei– adduction of 2nd, 3rd, and 4th fingers towards the axial line

C. Adductor pollicis– adduction of thumb

D. 3rd and 4th Lumbricals–

E. Hypothenar group of muscles, including:

i. Flexor digiti minimi brevis– flexion of little finger at metacarpophalangeal joint

ii. Abductor digiti minimi– abduction of little finger at metacarpophalangeal joint

iii. Opponens digiti minimi– opposition of little finger

42
Q

Medial cord gives off the following cutaneous branches that innervates the front and medial side of arm, and forearm:

A

Medial cord gives off the following cutaneous branches that innervates the front and medial side of arm, and forearm:

I. Medial brachial cutaneous nerve (Medial cutaneous nerve of arm)

II. Medial antebrachial cutaneous nerve (Medial cutaneous nerve of forearm)

42
Q

Ulnar nerve gives off the following cutaneous branches in hand and palm:

A

i. Palmar digital cutaneous nerve– innervates the medial part of palm

ii. Dorsal (posterior) cutaneous nerve– innervates the medial third of dorsum of hand

iii. Dorsal (digital) cutaneous nerves– innervates medial side of ring finger, and sides of little finger

43
Q

ways the ulnar nerve can be damaged

A
44
Q

when brachial plexus forms from branches it passes through ______

and supply of where in the body

A

After their formation, these nerves passes between the Scalenus anterior and Scalenus medius muscles to enter the base of neck

c) Supply motor, sensory (cutaneous/skin), and articular (joint) nerve fibers to chest, shoulder, arm, forearm, and hand regions

45
Q

Roots, Trunks, and Divisions reside ‘________r’, while cords are ‘_______r’

A

supraclavicular

infraclavicular

46
Q

anterior vs posterior divisions innervate what?

A
47
Q

________fibers innervates the muscles that act at shoulder or flex the elbow

A

C5 and C6 fibers innervates the muscles that act at shoulder or flex the elbow

48
Q

_________fibers innervates the muscles that are part of forearm or extend the elbow

A

C7 and C8 fibers innervates the muscles that are part of forearm or extend the elbow

49
Q

_____ fibers innervates the intrinsic muscles of hand

A

T1 fibers innervates the intrinsic muscles of hand

50
Q

brachial plexus gives rise to suprascapular nerve

A
51
Q

Clinical significance of Suprascapular nerve:

A
52
Q

Clinical significance of Dorsal scapular nerve C5:

A
53
Q

Upper subscapular nerve
vs Lower subscapular nerves

Clinical significance of Subscapular nerves

A

Upper subscapular nerve (C5):
Subscapularis (superior portion) muscle– adduction and medial rotation of arm

I. Subscapularis (inferior portion) muscle–adduction and medial rotation of arm
II. Teres major muscle– adduction and medial rotation of arm

Clinical significance of Subscapular nerves– Injury to subscapular nerve can cause a reduced ability to medially rotate, and adduct the arm

54
Q

Subclavian nerve (Nerve to subclavius, C5 and C6):

innervates

A

I. Subclavius muscle– anchoring, depressing and stabilization of clavicle bone, assists in lifting the ribs during respiration

II. Sternoclavicular joint

55
Q

Long Thoracic nerve

innervation

A

(C5 to C7),

Innervates Serratus anterior muscle–

56
Q

Clinical significance of Long thoracic nerve:

A
  • Winging of scapula

(C5 to C7),

Innervates Serratus anterior muscle whose contraction results in protraction of scapula, and assists in upward rotation of scapula bone, stabilizes scapula

57
Q

draw out brachial plexus

A
58
Q

nerves that innervate the arm

A
59
Q

________fibers innervates the muscles that act at shoulder or flex the elbow

_________fibers innervates the muscles that are part of forearm or extend the elbow

__________ fibers innervates the intrinsic muscles of hand

A

C5 and C6 fibers innervates the muscles that act at shoulder or flex the elbow

– C7 and C8 fibers innervates the muscles that are part of forearm or extend the elbow

T1 fibers innervates the intrinsic muscles of hand

60
Q
A
61
Q

subclavian nerve

inneravtes what joint

A

innervates

62
Q

clinical significance of thoraco dorsal

A
63
Q

lateral pectoral nerve

A
64
Q

clinical significance to lateral pectoral nerve

A
65
Q

Medial pectoral nerve

A
66
Q

Axillary nerve innervates

A

ix) Axillary nerve (C5 and C6):
a) Terminal branch of Posterior cord of Brachial plexus, receiving fibers from C5 and C6

b) Innervates the following:
I. Deltoid– which causes shoulder abduction, and flexion, abduction, and rotation of arm
II. Teres minor– which causes lateral rotation of upper arm III. Acromioclavicular and Glenohumeral (shoulder) joints

67
Q

_______ gives off the Superolateral brachial cutaneous nerve (Superior upper lateral cutaneous nerve of arm)– skin over the superolateral arm

A
68
Q

– fall from a tree
– dislocations of shoulder joint
– compression of axilla with a crutch – fracture of surgical neck of Humerus

A

Axillary nerve may be injured

69
Q

Injury to Axillary nerve can result in:

A
  • paralysis of the teres minor muscle and deltoid muscle, resulting in loss of abduction of arm, weak flexion, extension, and rotation of shoulder
  • loss of sensation in the skin over the over the superior part of lateral aspect of arm
70
Q

know where musculocutaneous is located

A
71
Q

musculocutaneous Gives off______

A

Gives off the Lateral antebrachial cutaneous nerve (Lateral cutaneous nerve of forearm)

72
Q

clinical significance of musculocutaneous

A
73
Q

median nerve gives off

A

both ulna and median nerve give rise to palmar cutaneous and palmar digital

74
Q

Carpel tunnel (canal):

A
75
Q

_______ Gives off Posterior Interosseous nerve, which provide motor supply to following muscles:

A

Radial nerve (C5 to T1)

I. Extensor carpi radialis brevis– cause extension and abduction of wrist
II. Supinator– whose primary action is supination of forearm
III. Extensor digitorum– cause extension of proximal interphalangeal and
metacarpophalangeal joints of 2nd, 3rd, 4th, and 5th fingers
IV. Extensor digiti minimi– whose primary action is extension of little finger at interphalangeal and metacarpophalangeal joints
V. Extensor carpi ulnaris– whose primary action is extension and adduction of wrist
VI. Extensor pollicis longus- whose primary action is extension of thumb at carpometacarpal, metacarpophalangeal, and interphalangeal joints
VII. Extensor pollicis brevis– whose primary action is extension of thumb at carpometacarpal, and metacarpophalangeal joints
VIII. Extensor indicis– whose primary action is extension of little finger
IX. Abductor pollicis longus– whose primary action is abduction of thumb at carpometacarpal, and metacarpophalangeal joints

extensors and supinators

75
Q

Fracture of distal end of Humerus bone (Supracondylar fracture)– can lead to

A

Median nerve injury, which can result in weakness of middle and index fingers to contract, with weakness of wrist flexion (Hand of benediction)

76
Q

radial nerves gives off

A

posterior aspect of arm, and the posterolateral aspect of the wrist, and hand:

I. Posterior brachial cutaneous nerve (Posterior cutaneous nerve of arm)

II. Posterior antebrachial cutaneous nerve (Posterior cutaneous nerve of forearm)

IV. Inferiolateral brachial cutaneous nerve (Inferior lateral cutaneous nerve of arm)

Gives off the Dorsal digital cutaneous nerves that innervates the– skin at the lateral 2/3rd of dorsum of hand, and posterior surfaces over the proximal phalanges of lateral three and a half fingers (Remainder of each fingers is innervated by Palmar digital branches of Median and Ulnar nerves)

77
Q

radial nerve injury can lead to

A
78
Q

how can the radial nerve be injured

A

Fracture of mid-shaft or radial groove or lateral epicondyle of Humerus bone, Improper use of crutches (prolonged compression in axillary region), person gets drunk on Saturday night and ends up falling asleep on a chair with arm hanging over the back of chair (Saturday night palsy) can cause– Radial nerve injury, which can lead to:
i. wrist drop (loss of wrist extension due to inability to extend the hand and fingers) ii. loss of sensory, and motor functions in posterior arm, forearm, and hand

79
Q

Erb-Duchenne palsy– Injuries to the upper (superior) parts of
Brachial plexus (C5 and C6) can occur due to

4 examples given

A

excessive stretching of neck of a neonate during the delivery process, shouler distocia

fall from a motorcycle or a horse, and landing on the shoulder

chronic microtrauma to superior trunk of Brachial plexus from carrying heavy backpack for longer time (e.g, hickers) can cause sensory and motor deficits in the distribution of– Musculocutaneous and Radial nerves

acute brachial plexus neuritis (neuropathy) -inflammation of nerves

prolonged hyperduction of arm when someone is trying performing some manual tasks over the head (e.g, painting a ceiling)

Hyperabduction syndrome- compresssion of axillary vessels

compression of nerves (e.g, Carpel tunnel syndrome, Guyon tunnel syndrome

80
Q

Signs and symptoms of Erb-Duchenne palsy– Injuries to the upper (superior) parts of
Brachial plexus (C5 and C6)

A

affected limb hangs limply, adducted and medially rotated

excessive extension at elbow joint

forearm is pronated

wrist is weakly flexed due to the normal tone of wrist flexors relative to the weakened wrist extensors– Waiter’s tip position

loss of sensation in the lateral aspect of forearm

81
Q

Erb’s palsy (injury to _____

A

presents as damage to superior (upper) part of Brachial plexus

82
Q

Klumpke’s paralysis-

A

Injuries to the lower (inferior) parts/ inferior trunk of Brachial plexus (C8 and T1) can occur when:
i. upper limb is suddenly pulled superiorly

klaw fingers

83
Q

Signs and symptoms Klumpke’s paralysis-

A

MSK (7 decks)

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