Exam #6: Brachial Plexus Flashcards
From what levels is the brachial plexus derived?
Ventral rami of C5-T1
What is the preaxial side of the upper limb?
Lateral thumb side
What is the post-axial side of the upper limb?
Medial side of the arm
Draw the dermatomal distribution of the upper limb.
N/A
What is a myotome? How does the myotome distribution differ from the dermatomal distribution?
Set of muscle innervated by a specific nerve root
What does the C5 myotome control?
Elbow Flexion
Abduction (at shoulder)
What does the C6 myotome control?
Wrist extension
What does the C7 myotome control?
- Elbow extension
- Wrist flexion
- Digital extension
What does the C8 myotome control?
Digital flexion
What does the T1 myotome control?
Abduction & Adduction of the fingers
What does the biceps reflex test?
C5
What does the brachioradialis reflex test?
C6
What does the triceps reflex test?
C7
A patient presents in your office and is unable to flex his arm at the elbow or abduct his arm at the shoulder. What myotome is involved?
C5
A patient presents in your office and is unable extend his wrist? What myotome is involved?
C6
A patient presents in your office and is unable extend his arm at the elbow, flex his wrist, or extend his digits. What myotome is involved?
C7
A patient presents in your office and is unable to flex his digits. What myotome is involved?
C8
A patient presents in your office and is unable to adduct or abduct his fingers. What myotome is involved?
T1
Describe the compartments of the upper arm.
The upper arm is divided into anterior & posterior compartments.
What compartment do the anterior divisions of the brachial plexus innervate?
Anterior compartment muscles
What compartment do the posterior divisions of the brachial plexus innervate?
Posterior compartment muscles
What is the mnemonic to remember the organization of the brachial plexus?
Randy= Roots (ventral rami of C5-T1) Travis= Trunks Drinks= Divisions Cold= Cords Beer= Branches
List the trunks of the brachial plexus.
Upper
Middle
Lower
List the division of the brachial plexus.
Anterior
Posterior
List the cords of the brachial plexus.
Lateral
Medial
Posterior
What is the landmark around which the cords of the brachial plexus are described?
Axillary a.
What are the five terminal branches of the brachial plexus?
Musculocutaneous Axillary Radial Median Ulnar
Draw & label the brachial plexus.
N/A
Draw the cutaneous innervation of the upper limb from the anterior view.
N/A
Draw the cutaneous innervation of the upper limb from the posterior view.
N/A
From what cervical level does the dorsal scapular nerve originate?
C5
From what cervical levels does the long thoracic nerve originate?
C5, 6, & 7
From what cervical levels does the suprascapular nerve originate?
C5 & C6
From what cervical levels does the nerve to subclavis originate?
C5 & C6
From what cervical levels does the lateral pectoral nerve originate?
C5, 6 & 7
From what cervical levels does the median pectoral nerve originate?
C8 & T1
From what cervical levels does the medial brachial cutaneous nerve originate?
C8 & T1
From what cervical levels does the medial antebrachial cutaneous nerve originate?
C8 & T1
From what cervical levels does the upper subscapular nerve originate?
C5 & C6
From what cervical levels does the lower subscapular nerve originate?
C5 & C6
From what cervical levels does the thoracodorsal nerve originate?
C 6, 7 & 8
From what cervical levels does the axillary nerve originate?
C5 & C6
From what cervical levels does the radial nerve originate?
C5, 6, 7, & 8
From what cervical levels does the musculocutaneous nerve originate?
C5, 6, & 7
From what cervical levels does the median nerve originate?
C6, 7, 8, & T1
From what cervical levels does the ulnar nerve originate?
C8 & T1
What muscles does the dorsal scapular nerve innervate?
Rhomboids
Levator Scapulae
What muscle does the long thoracic nerve innervate?
Serratus anterior
What muscles does the supraclavicular nerve innervate?
Supraspinatous
Infraspinatous
What muscle does the lateral pectoral nerve innervate?
Pectoralis major
What muscle does the medial pectoral nerve innervate?
Pectoralis major
Pectoralis minor
What muscle does the upper subscapular nerve innervate?
Subscapularis
What muscle does the lower subscapular nerve innervate?
Supscapularis
Teres major
What is the alternate name for the thoracodorsal nerve? What muscle does this nerve innervate?
Thoracodorsal= “Middle subscapular nerve.”
- Lat. dorsi
What group of muscles does the musculocutaenous branch innervate?
Anterior arm
What muscles does the axillary branch innervate?
Deltoid
Teres minor
What group of muscles does the radial branch innervate?
Posterior arm
Posterior forearm
What group of muscles does the median branch innervate?
Anterior forearm
What group of muscles does the ulnar branch innervate?
Hand
What is Erb’s palsy? What typically causes Erb’s palsy?
This is an upper brachial plexus (C5/C6) injury caused by:
1) Fall on neck
2) Pull on head during birth
3) Football (stinger)
What is the deformity that is pathognomonic for Erb’s Palsy?
“Waiter’s Tip”
Describe the muscular presentation of Erb’s Palsy.
The effected arm is:
- Adducted (C5)
- Medially rotated (C5)
- Elbow extended (C5)
- Wrist Flexed (C6)
What sensation will be affected by Erb’s Palsy?
Lateral arm
Lateral forearm
Lateral hand
What is Klumpke’s Paralysis? What typically causes Klumpke’s Palsy?
This is a lower brachial plexus injury (C8 &T1) caused by:
1) Arm overhead stretch i.e. “Strap-Hanger’s Palsy”
2) Arm pull during birth
What deformity is pathognomonic for Klumpke’s Palsy?
Full hand claw
Describe the muscular presentation of Klumpke’s Palsy.
- Finger extension (C8)
- Inability to abduct or adduct fingers
Describe the sensory presentation of Klumpke’s Palsy.
Paresthesias along the medial hand, forearm, and arm
What is Horner Syndrome? What are the three cardinal symptoms of Horner Syndrome?
This is a lower brachial plexus injury that leads to loss of T1 sympathetic innervation. Presentation is:
1) Pitosis
2) Anhydrosis
3) Miosis (constriction)