Brachial plexus Flashcards

1
Q

What is the course of the brachial plexus?

A
  • originates in neck
  • passes laterally and inferiorly over rib 1
  • enters axilla
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2
Q

What makes up the roots of the brachial plexus?

A

ventral rami of spinal nerves C5-T1

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3
Q

How many trunks are there?

A

3: superior, middle, inferior

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4
Q

What makes up the superior trunk?

A

roots C5 and C6 joining

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5
Q

what makes up the middle trunk?

A

root of C7 alone

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6
Q

what makes up the inferior trunk?

A

roots of C8 and T1 joining

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7
Q

what are divisions made of?

A

each of the trunks have an anterior and posterior division

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8
Q

what do the 3 anterior divisions form?

A

forms part of the brachial plexus that ultimately give rise to peripheral nerves associated with anterior compartment of arm/forearm

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9
Q

what do the 3 post divisions combine to form?

A

form parts that give rise to nerves associated with posterior compartments

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10
Q

what are the cord positions described with respect to?

A

to the axillary artery

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11
Q

what makes up the posterior cord?

A

posterior divisions of all 3 trunks
contributions from C5-T1
posterior to second part of axillary artery

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12
Q

what makes up the lateral cord?

A

anterior divisions of superior and middle trunk
contributions from C5-C7
lateral to 2nd part of axillary artery

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13
Q

what makes up the medial cord?

A

anterior divisions of inferior trunk alone
contributions from C8-T11
medial to second part of axillary artery

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14
Q

where do the nerves associated with the anterior compartment come from?

A

medial and lateral cord

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15
Q

where do the nerves associated with the posterior compartment come from?

A

posterior cords

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16
Q

what are the major terminal branches of the brachial plexus?

A
  • musculocutaneous nerve
  • median nerve
  • axillary nerve
  • radial nerve
  • ulnar nerve
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17
Q

what does the musculocutaneous nerve innervate?

A
  • innervates all of anterior compartment of arm
  • brachialis, biceps brachii, coracobrachialis
  • branches off lateral cord
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18
Q

what does the median nerve innervate?

A
  • most of the flexors of wrist
  • thenar muscles
  • formed by joining of medial and lateral cords
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19
Q

what does the axillary nerve innervate?

A
  • deltoid and teres minor

- branches off posterior cord

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20
Q

what does the radial nerve innervate?

A
  • all posterior arm and forearm
  • some sensory innervation to hand
  • terminal branch of posterior cord
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21
Q

what does the ulnar nerve innervate?

A
  • some flexors (FCU, half of FDP)
  • most of intrinsic muscles of hand
  • terminal branch of medial cord
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22
Q

what are the branches off the roots?

A
  • long thoracic nerve

- dorsal scapular nerve

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23
Q

what is the long thoracic nerve? what does it innervate?

A
  • innervates serratus anterior

- contributed by C5, 6, 7 ventral rami directly

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24
Q

what is the dorsal scapular nerve? what does it innervate?

A
  • branch of ventral rami of C5

- innervates rhomboids

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25
Q

what happens when there is damage to the dorsal scapular nerve?

A

patient unable to bring their inferior angle of the scapula together

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26
Q

what are the branches off the trunks?

A
  • originate from superior trunk
  • suprascapular nerve
  • nerve to subclavius muscle
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27
Q

what is the suprascapular nerve? what does it innervate?

A
  • direct branch of superior trunk

- innervates supraspinatus, infraspinatus, glenohumeral joint

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28
Q

what is the nerve to the subclavius? what does it innervate?

A

innervates subclavius

C5/6

29
Q

what are the branches off the lateral cord? (not terminal branches)

A

lateral pectoral nerve

30
Q

What is the lateral pectoral nerve?

A
  • branch of lateral cord

- innervating pec major

31
Q

what are the branches off the medial cord? (not terminal branches)

A
  • medial pectoral nerve
  • medial cutaneous nerve of arm
  • medial cutaneous nerve of forearm
32
Q

what is the medial pectoral nerve?

A
  • branch of medial cord

- innervates pec minor

33
Q

what is the medial cutaneous nerve of the arm?

A
  • innervates upper part of medial surface of arm/ floor of axilla
34
Q

what is the medial cutaneous nerve of forearm?

A
  • innervates skin over medial surface of forearm down to wrist
35
Q

what are the branches off the posterior cord? (not terminal branches)

A
  • thoracodorsal nerve
  • upper subscapular
  • lower subscapular
36
Q

what is the thoracodorsal nerve?

A
  • branch of posterior cord

- innervating lattissimus dorsi

37
Q

what is the upper subscapular nerve?

A
  • branch of posterior cord

- innervating upper part of subscapularis

38
Q

what is the lower subscapular nerve?

A
  • branch of posterior cord

- innervating inferior portion of subscapularis and teres major

39
Q

what are the shoulder girdle muscles innervated by? (motor innervation)

A

C5-7

40
Q

what are the shoulder joint muscles and elbow flexors innervated by? (motor innervation)

A

C5, C6

41
Q

what are the elbow extensors innervated by? (motor innervation)

A

C7-8

42
Q

what provides the motor innervation to the wrist and coarse hand muscles?

A

C6-8

43
Q

what provides the motor innervation to the small muscles of the hand?

A

C8-T1

44
Q

how do you test the spinal nerve C5?

A

test sensation just anterior to elbow

45
Q

how do you test the spinal nerve C6?

A

test sensation in tip of thumb

46
Q

how do you test the spinal nerve C7?

A

test sensation in middle finger

47
Q

how do you test the spinal nerve C8?

A

test sensation in little finger

48
Q

how do you test the spinal nerve T1?

A

test sensation on medial aspect of upper arm

49
Q

what are the branches of the radial nerve?

A
  • posterior cutaneous nerve of arm + forearm
  • inferior lateral cutaneous nerve of arm
  • superficial branch
50
Q

what does the radial nerve innervate?

A
  • medial part of posterior upper arm
  • posterior lateral part of forearm
  • lateral part of lower arm + forearm
  • lateral part of dorsal hand
  • some sensation in thenar eminence
51
Q

what does the ulnar nerve give innervation to?

A
  • medial part of anterior arm below elbow
52
Q

what does the dorsal cutaneous branch of the ulnar nerve give sensation to?

A
  • small digit and half of ring finger on dorsal and palmar sides
53
Q

what does the axillary nerve give innervation to?

A
  • regimental patch

= lateral aspect of upper part of arm near shoulder joint

54
Q

what forms the lateral cutaneous nerve?

A

given off by musculocutaneous nerve

55
Q

what does the lateral cutaneous nerve supply?

A
  • medial part of anterior aspect of lower 2/3rds of arm

- crosses over at elbow to supply lateral part of anterior distal 2/3rds of forearm

56
Q

what happens when there is injury to the axillary nerve?

A
  • unable to raise arms

- wasting of deltoid

57
Q

what happens when there is injury to the radial nerve?

A
  • can’t extend elbow joint or wrist joint
  • loss of sensation of lateral part of arm/forearm
  • wrist drop
  • loss of power grip
58
Q

what happens when there is injury to ulnar nerve?

A
  • ulnar claw

- unable to adduct or abduct fingers

59
Q

what happens when there is injury to median nerve?

A
  • paraesthesia of lateral half of palmar side of hand
  • muscle wasting of thenar muscles and thenar eminence
  • hand of benediction (when try to flex fingers, only last 2 will flex)
60
Q

what happens when there is injury to the long thoracic nerve?

A
  • winging of scapula
61
Q

what causes damage to the upper roots?

A
  • hyperextension of spine/neck

- stretching of plexus by excessive pulling shoulder

62
Q

what is damage to the upper roots known as?

A

Erb’s palsy

63
Q

when there is damage to the upper roots, which nerves are affected?

A
  • radial
  • musculocutaneous
  • median
  • axillary
64
Q

what happens when there is damage to the upper roots?

A
  • arm drop, due to loss of deltoid
  • pronation of hand, due to loss pf biceps
  • flexion of hand, due to loss of extensor muscles of wrist
65
Q

what causes damage to the lower roots?

A
  • hyperabduction of shoulder due to gripping overhead to break fall
  • pulling on arm of a child during childbirth
66
Q

what is damage to the lower roots known as?

A

Kumpke’s palsy

67
Q

when there is damage to the lower roots, which nerves are affected?

A

main issues on ulnar and median nerve

68
Q

what happens when there is damage to the lower roots?

A
  • loss of flexion of wrist
  • loss of extension of last 2 digits
  • limited hand movements
  • loss of thumb movements