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Neurological, neuromuscular and musculoskeletal disease > The axilla and brachial plexus > Flashcards

The axilla and brachial plexus Flashcards

1
Q

What is the lateral wall of the axilla made up from?

A

The humerus

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2
Q

Importance of the axilla?

A

An important place for things which serve the upper limb to enter and leave such as vessels and nerves

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3
Q

Which muscles are found medially, posteriorly and anteriorly to the axilla?

A

Medial: serratus anterior
Posterior: subscapular muscles
Anterior: pectoral muscles

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4
Q

The apex of the axilla forms a triangle between…

- What is the relevance of this triangle?

A

The 1st rib, the superior margin of the scapula and the clavicle
- It is over the first rib that major vessels and nerves pass, through this triangle area, to enter the axilla and serve the upper limb

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5
Q

What are the contents of the axilla?

A

Axillary vessels - Axillary vein and artery
Axillary lymphatics
Brachial plexus

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6
Q

Where does the axillary vein pass under the clavicle? Why is this clinically relevant

A

At the junction of the medial third and middle third
- Clinically important as you can put a needle into this vein and insert a line, which is an access point/line to the heart and venous system

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7
Q

What are the 5 named lymph node groups through which lymphatic vessels drain the breast and upper limb and enter the axillary lymphatic system?

A
  1. Lateral
  2. Subscapular
  3. Pectoral
  4. Central
  5. Apical
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8
Q

What is the brachial plexus?

A

A network of nerves that forms between the emergence of spinal nerves that are supplying the upper limb from the lateral aspect of the vertebral column through the vertebral foramen
- Supply motor and sensation to the upper limb

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9
Q

From which vertebral level does the brachial plexus originate?

A

C5-T1

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10
Q

The roots of the brachial plexus are formed from?

A

Ventral primary rami

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11
Q

The brachial plexus branches go from roots –>….

A

Roots –> Trunks –> Divisions –> Cords

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12
Q

How many trunks does the brachial plexus have? How do the cervical vertebrae C5-T1 contribute to this?

A

3 - superior, middle and inferior

  • C5 & C6 merge to give the superior trunk
  • C7 forms the middle trunk
  • C8/T1 have merged to give the inferior trunk
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13
Q

How do each of the trunks of the brachial plexus divide?

A

Each trunk divides into a posterior and anterior division

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14
Q

Which of the brachial plexus cords do the superior and middle trunk contribute to?

A

The lateral and posterior cords

Superior anterior –> lateral cord
Superior posterior –> posterior cord

Middle anterior –> lateral cord
Middle posterior –> posterior cord

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15
Q

Which of the brachial plexus cords does the inferior trunk contribute to?

A

The posterior and medial cords of the brachial plexus

Inferior posterior –> posterior cord
Inferior anterior –> medial cord

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16
Q

What happens to the lateral, posterior and medial cords of the brachial plexus?

A

They branch to form peripheral nerves that supply the skin with sensation and motor to muscles of the UPPER LIMB

17
Q

What is the principal nerve which originates from the lateral cord of the brachial plexus?

A

The musculocutaneous nerve

- This is formed by the anterior division of the brachial plexus

18
Q

Where does the musculocutaneous nerve supply?

A

The uppermost part of the upper limb

  • Coracobrachialis
  • Biceps brachii
  • Brachialis
  • FLEXORS
19
Q

The anterior divisions of nerve plexuses give rise to nerves that supply which muscle types?

A

Flexors and adductors

20
Q

The posterior cord of the brachial plexus has two main branches, what are they?

A

Axillary nerve

Radial nerve

21
Q

Where does the radial nerve supply?

A

It supplies motor to extensor muscles of the upper arm, then travels through the radial groove into the forearm where it supplies many of the extensor muscles here.
- It also has a long sensory branch which supplies the dorsum of the hand

22
Q

The anterior division of the medial and lateral cords of the brachial plexus come together to form which nerve?

A

The median nerve

23
Q

Where does the median nerve supply?

A

It passes through the arm without giving off any branches BUT it supplies the FLEXOR muscles of the forearm and a few muscles in the hand, more so the radial aspects where the thumb is

24
Q

The anterior division of the medial cord gives rise to which nerve?

A

The ulnar nerve

25
Q

Where does the ulnar nerve supply?

A

It passes, like the median nerve, all the way through the arm to supply just a few muscles in the forearm and many small muscles in the hand

26
Q

The sensory fibres carried by the median nerve supply…

A

The thumb, the index finger and half of the ring finger

27
Q

The sensory fibres carried by the ulnar nerve supply…

A

The other half of the ring finger and the little finger

28
Q

The sensory fibres carried by the radial nerve supply…

A

The dorsum of the hand

  • Exclusively to the webbing of the thumb and index
  • As does the ulnar nerve’s dorsal branch
29
Q

Where does the median nerve EXCLUSIVELY supply sensation?

A

Tip of the index and middle fingers

30
Q

Where does the ulnar nerve EXCLUSIVELY supply sensation?

A

At the tip of the little finger

31
Q

Where does the radial nerve EXCLUSIVELY supply sensation?

A

At the webbing between the thumb and index

32
Q

What is the innervation type supplied by the brachial plexus?

A

Segmental

33
Q

What is meant by a segmental pattern of innervation?

A

The muscles are innervated by particular spinal nerves from particular segments

  • Segmental innervation refers to the distribution (innervation) of nerves within an organ or muscle. These nerves are attached to a segment of the spine. Segmental innervation can be mapped through stimulation of the nerve at the spinal segment.
34
Q

The muscles of the upper arm, particularly the shoulder, are innervated by which vertebral segments?

A

C5 and C6

35
Q

The lower segments of the arm, including the fingers and thumbs are innervated by which vertebral segments?

A

C6, C7 and C8

36
Q

The hand is innervated by which vertebral segment? Clinical importance?

A

Th1
- V IMPORTANT as any injury to Th1 will paralyse the intrinsic muscles of the hand, we wont be able to perform fine movements (adduction/abduction of digits)

37
Q

What is Erb’s palsy? Clinical manifestation?

A

An injury to the upper roots of the brachial plexus - C5 and C6

  • Affects upper myotomes and dermatomes
  • Results in paralysis to muscles around shoulder and arm hangs limply by the side
38
Q

What is Klumpke’s paresis? Causes?

A

Injury to the lower roots of the brachial plexus, particularly Th1

  • Th1 supplies sensation over medial side of forearm and supplies motor sensation to small muscles of the hand (adduction/abduction of digits) - so this is lost
  • Through birth injuries or stabs & gunshot wounds

Neurological, neuromuscular and musculoskeletal disease (36 decks)

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