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C1 Modules > Brachial plexus > Flashcards

Brachial plexus Flashcards

1
Q

What is brachial plexus?

A

A network of nerves innervating muscles of the shoulder, upper chest and arm

Anterior rami of C5 through T1

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2
Q

Where does brachial plexus extend from?

A

Cervical neural foramina to axilla

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3
Q

What is brachial plexus closely related to?

A

Scalene muscles

Subclavian artery

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4
Q

Where does the brachial plexus begin?

A

Root of neck, passes through the axilla and runs through entire upper extremity

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5
Q

What is the brachial plexus formed by?

A

Anterior rami of cervical spinal nerve C5, C6, C7 and C8 and first thoracic spinal nerve, T1

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6
Q

What are the 5 parts that the brachial plexus is divided into?

A
  1. Roots
  2. Trunks
  3. Division
  4. Cord
  5. Branches
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7
Q

What does the roots refer?

A

Anterior rami of spinal nerves that comprise the brachial plexus

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8
Q

What are the anterior rami of spinal nerves?

A

C5, C6, C7, C8 and T1

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9
Q

Where does parties spinal nerves arise?

A

At each vertebral level

They leave the spinal cord via intervertebral foramina of vertebral column

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10
Q

What does each spinal nerve divide into?

A

Anterior and posterior ramps

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11
Q

What happens after the formation of the roots?

A

The nerves pass between anterior and medial scalene muscled to enter base of neck

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12
Q

What happens at the base of the neck?

A

Roots of brachial plexus converge to form 3 trunks

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13
Q

what are the 3 trunks?

A
  1. Superior trunk: combination of C5 and C6 roots
  2. Middle trunk: combination of C7
  3. Inferior trunk: combination of C8 and T1 roots
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14
Q

Where does the trunks traverse?

A

Laterally, crossing posterior triangle of neck

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15
Q

What does each trunk divide into?

A

2 branches within posterior triangle of the neck

One division moves anteriorly and other posteriorly (anterior and posterior divisions)

3 anterior nerve fibre
3 posterior nerve fibre

Divisions leave posterior triangle and pass into axilla

They recombine into cord of brachial plexus

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16
Q

What happens once the anterior and posterior divisions have entered the axilla?

A

They combine together to form 3 cords

Baked by their position relative to axillary artery

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17
Q

What are the 3 cords?

A
  1. Lateral cord
  2. Posterior cord
  3. Medial cord
18
Q

Lateral cord

A
  1. Anterior division of superior trunk

2. Anterior division of middle trunk

19
Q

Posterior cord

A
  1. Posterior division of superior trunk
  2. Posterior division of middle trunk
  3. Posterior division of inferior trunk to
20
Q

Medial cord

A
  1. Anterior division of inferior trunk
21
Q

What do the cords give rise to?

A

Major branches of brachial plexus

22
Q

Where does the subclavian artery extend along?

A

Floor of interscalene triangle between anterior and middle scalene muscles

23
Q

What does the supraclavicular plexus include?

A

Roots and trunks

24
Q

Where is the retroclavicular plexus located?

A

Costoclavicular space, above subclavian artery and vein

25
Q

What does the subclavian artery form?

A

Floor of interscalene triangle

26
Q

What does the subclavian artery and vein take ?

A

Name of axillary artery and vein at lateral border of 1st rib

27
Q

What merges at dorsal root ganglion?

A

At each vertebral level
Anterior-motor
Posterior-sensory riots exiting from spinal cord within neural foramina

28
Q

What do both rami include?

A

A mixture of motor and sensory fibres

29
Q

What forms brachial plexus?

A

Anterior rami

30
Q

Why imaging?

A

Most brachial plexopathies present with vague and non-specific symptoms

Purely/mostly motor symptoms are generally seen in young patients: usually preganglionic; stretch injury

Mixed sensory and motor plexopathy - usually in older patients, usually post-ganglionic; tumours

Clinical diagnosis: electrodiagnostic studies e.g. ENMG

31
Q

Brachial plexopathy

A

A form of peripheral neuropathy
It occurs when there is damage to brachial plexus
Direct injury to the verge; stretching injuries; pressure from Tumours in area or damage that results from radiation therapy

32
Q

What are specific symptoms of brachial plexopathy?

A
  1. Brown-seguards syndrome
  2. Ipsilateral phrenic nerve involvement
  3. Ipsilateral scapular singing
  4. Ipsilateral Horner’s syndrome
33
Q

Site of injury for brown-seguards syndrome

A

Spinal cord ipsilateral to avulsion

34
Q

Site of injury for ipsilateral phrenic nerve involvement

A

Supraclavicular brachial plexus involving roots, trunks or both

35
Q

What is site of injury for ipsilateral scapular winging

A

Proximal branches of C5 through C7

36
Q

What is site of injury for ipsilateral Horner’s syndrome?

A

Infraclavicular plexus

37
Q

What are medications for brachial plexus?

A
  1. Mass involving the plexus (intrinsic/extrinsic)
  2. Traumatic injury (preganglionic/postganglionic)
  3. Entrapment syndromes (thoracic outlet syndromes: sites of compression)
  4. Post-treatment evaluation (recurrent tumour vs radiation injury)
  5. Others (diffuse/focal pathology)
38
Q

What is magnetic resonance (MR) neurography?

A

Group of techniques with the potential to allow optimal non-invasive evaluation of many abnormalities of brachial plexus

  1. Structural
  2. Microstructural
39
Q

What MRI is used to observe brachial plexus? I’m

A
  1. Coronal STIR sequences - cover both sides
  2. Sagittal STIR sequences on each side
  3. Coronal T1w volumetric, isometric with and without gadolinium
40
Q

What is structural MR neurography?

A

Evaluation of longitudinal axis of peripheral nerve

41
Q

What are abnormal findings of brachial plexus?

A
  1. Loss of fat planes around all or part of a plexus component
  2. Diffuse or focal enlargement of a component
  3. Presence of an eccentric or modular mass
  4. Marked hyperintensity on STIR
  5. Enhancement on T1-w images with fat suppression
  6. Altered fasicular pattern

C1 Modules (20 decks)

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