CERVICAL and BRACHIAL PLEXUSES Flashcards
Brachial plexus roots arise from
ventral rami from C5 to T1
Parts of the Brachial Plexus
RTDCB
Roots Trunks Divisions Cords Branches
Roots are
C5-T1
Trunks are
Superior
Medial
Inferior
Divisions are
6 divisions
Cords are
Lateral, Posterior and medial according to relationship with Axillary artery
The cords divide into terminal branches that supply
all motor and sensory innervations of the upper extremities
The cords divide into terminal branches that supply all motor and sensory innervations of the upper extremities
EXCEPT
Skin over the shoulder (Cervical plexus)
Medial aspect of the arm (Supplied by intercostobrachial branch of the 2nd intercostal nerve)
What plexus cover skin over the shoulder?
Cervical plexus
What nerve branch cover medial aspect of the arm?
Intercostobrachial branch of the 2nd intercostal nerve.
Brachial plexus PNB nerve involve
Interscalene
Supraclavicular
Infraclavicular
Axillary
2 nerves to cover for elbow
Infraclavicular
Axillary
Cervical plexus blocks provide
analgesia and anesthesia to the neck
Some surgeries for cervical plexus block
Neck surgeries
Carotid endarterectomy
Cervical plexus is composed of the rami of
C1 to C4 forming the five main branches
What are the 5 branches of the cervical plexus blocK?
Cutaneous branches Ansa Cervical is Phrenic Nerve Components of the accessory nerve Direct muscular branches innervate the prevertebral muscles of the neck
What precautions must be taken for patients with carotid endarterectomy ?
The head should not be extended excessively or turned aggressively to prevent cerebral ischemia or embolic stroke from a dislodged clot.
The cutaneous branches supply the
Lesser occipital
Greater auricular
Transverse Cervical
Supraclavicular nerve
The Ansa cervicalis supplies the
Geniohyoid and Infrahyoid muscles
The phrenic nerve innervates the
Diaphragm
Direct muscular branches innervate the
Prevertebral muscles of the neck
Accessory nerves innervate
Sternocleidomastoid
Trapezius muscles
Superficial Cervical plexus block process
Posterior border of SCM identified and outlined
A line is drawn between the mastoid process and the clavicular head of the SCM
The Midpoint of the line is the injection site.
Needle is inserted PERPENDICULAR to the skin
Block starts within 10-15 mns
Deep cervical Plexus block : what needs to be identified first?
Transverse process of C6 (Chassaignac’s Tubercle)
Where is the Chassaignac’s Tubercle palplable?
at the level of the cricoid cartilage.
Intercostobrachial nerve arises from
T2
Intercostobrachial nerve: Block that blocks this nerve
Field Block
Sensory test for Axillary nerve
Pinch lateral aspect of shoulder
Motor test for Axillary nerve
Arm abduction (deltoid contraction)
Sensory test for Musculocutaneous nerve
Pinch lateral aspect of forearm
Motor test for Musculocutaneous nerve?
Elbow Flexion (biceps contraction)
Motor test for median nerve
Thumb Opposition
Sensory test for Median Nerve
Pinch index finger
Sensory test for Radial nerve
Pinch webspace between thumb and index finger
Motor test for Radial Nerve
Elbow extension ( tricepts contraction) Wrist and finger extension
Sensory test for Ulnar nerve
Pinch pinky finger
Motor test for Ulnar nerve
Pinky finger abduction
