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ANAT102 > Topic 6: Nerve supply of the Upper Limb > Flashcards

Topic 6: Nerve supply of the Upper Limb Flashcards

1
Q

What is a plexus?

A

Complex plait of nerves originating from ventral rami of spinal nerves
–> ventral rami = anterior divisions of spinal nerves

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2
Q

What does a plexus do?

A

redistributes nerve fibres from several spinal levels BEFORE forming peripheral nerves
–> gives some redundancy of nerve supply

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3
Q

Parts of the Brachial plexus

A
  1. roots
  2. trunks
  3. divisions
  4. cords
  5. branches
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4
Q

What does the Brachial plexus supply

A

all muscles of the upper limb

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5
Q

Root values of the brachial plexus

A

C5-T1

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6
Q

TRUNKS

1. Upper

A

merges from the C5 &6 roots

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7
Q

TRUNKS

2. middle

A

comes from the root C7

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8
Q

TRUNKS

3. lower

A

merges from the root values C8 & T1

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9
Q

DIVISIONS

A

anterior & posterior divisions that come off trunks

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10
Q

CORDS

1. lateral cord

A
  • lateral to axillary artery

- merge of the anterior divisions

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11
Q

CORDS

2. posterior cord

A
  • posterior to the axillary artery

- merge of the posterior divisions

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12
Q

CORDS

3. Medial

A
  • medial to the axillary artery

- originates just from the anterior division off the lower trunk

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13
Q

BRANCHES

A
  1. Musculocutaneous nerve
  2. axillary nerve
  3. radial nerve
  4. median nerve
  5. ulnar nerve
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14
Q

ORIENTATION

Where do the roots emerge between?

A

between scalene (neck) muscles (anterior & middle)

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15
Q

ORIENTATION

Where are the trunks?

A

superior to the clavicle

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16
Q

ORIENTATION

Cords

A
  • inferior to the clavicle

- named by their position relative to axillary artery

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17
Q

Branches from the roots & distribution

1. Dorsal scapular

A

rhomboids

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18
Q

Branches from the roots & distribution

2. Long thoracic (C5-C7)

A

serratus anterior

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19
Q

Branches from the trunks & their dist

1. suprascapular nerve

A

supraspinatus, infraspinatus

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20
Q

Branches from the trunks & their dist

2. nerve to subclavius nerve

A

Subclavius

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21
Q

How many branches are there from cords?

A

14

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22
Q

branches from cords(not peripheral)

A
  1. upper subscapular
  2. lower subscapular
  3. thoracodorsal
  4. medial cutaneous nerve of arm
  5. medial cutaneous nerve of forearm
  6. medial pectoral
  7. lateral pectoral
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23
Q

Branches from the cords (peripheral)

A
  1. axillary
  2. radial & posterior interosseus branch (PIN - pins supinator)
  3. musculocutaneous
  4. median and its anterior interosseus branch
  5. ulnar
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24
Q

THE BIG FIVE

1. Musculocutaneous

A

First branch; only goes to anterior arm

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25
Q

THE BIG FIVE

2. Axillary nerve

A

Next; dives deep into axilla

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26
Q

THE BIG FIVE

3. Radial nerve

A

Next; dives deep between heads of triceps (find out which heads)

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27
Q

THE BIG FIVE

4. Median nerve

A
  • formed by 2 cords (posterior & medial)

- runs straight down midline of anterior arm

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28
Q

THE BIG FIVE

5. Ulnar

A

most inferior branch formed by only one cord (medial)

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29
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Axillary Nerve root value

A

C5,6

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30
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Axillary Nerve motor distribution

A

deltoid, teres minor

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31
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Axillary Nerve sensory distribution

A

skin over deltoid, shoulder jt

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32
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Radial nerve root value

A

C5-T1

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33
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Radial nerve motor distribution

A

all UL extensors, brachoradialis, supinator, AbdPL

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34
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Radial nerve sensory distribution

A
  • skin of the posterior arm, forearm and hand (lateral 3.5 digits), wrist & elbow jts
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35
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Musculocutaneous root value

A

C5,6,7

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36
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Musculocutaneous motor distribution

A

coracobrachialis, biceps brachii, brachialis

37
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Musculocutaneous sensory distribution

A
  • skin of lateral forearm to base of thumb (via the lateral cutaneous nerve of the forearm), elbow jt
38
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Median nerve root value

A

C5-T1

39
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Median nerve motor distribution

A

FCR, PL, both pronators, FDS, FDP (lat), FPL, AbdPB, FPB, OppPoll, lat 2 lumbricals
HALF LOAF

40
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Median nerve sensory distribution

A
  • skin of the lateral 3.5 digits and corresponding palm, wrist and elbow jts
41
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Ulnar nerve RV

A

C8-T1

42
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Ulnar nerve motor dist

A

FCU, FDP(medial), PB, AbdDM, FDM, OppDM, med 2 lumbricals, addPoll, all interossei

43
Q

DISTRIBUTION OF THE BRANCHES OF THE BRACHIAL PLEXUS

Ulnar nerve sensory dist

A

skin of the medial 1.5 digits and corresponding palm, wrist jt

44
Q

Where does the musculocutaneous nerve originate from?

A

the lateral cord (C5-C7)

45
Q

Course of the musculocutaneous nerve

A
  1. starts lateral to axillary artery
  2. descends & pierces the corachobrachialis
  3. runs between biceps & brachialis
46
Q

Branches of the musc nerve

A

lateral cutaneous nerve of forearm

47
Q

Vulnerable sites

A
  • not especially vulnerable to injury

- injuries @ birth could be a cause

48
Q

Where does the axillary nerve originate from?

A

posterior cord (C5-6)

49
Q

Course of the axillary nerve

A
  • starts posterior to axillary artery
  • dives deep into shoulder (quad space)
  • supplies shoulder jt
  • ant branch winds around neck of humerus to supply deltoid
  • post branch to supply deltoid & teres minor
50
Q

What does the ant branch of the axillary nerve supply

A

winds around neck of humerus to supply deltoid

51
Q

What does post branch of axillary nerve supply?

A

deltoid & teres minor

52
Q

Branches of the axillary nerve

A

superior/ upper lateral cutaneous nerve of arm (vaccine area)

53
Q

Axillary nerve vulnerable to injury

A

shoulder dislocation (because wraps around humeral neck)

54
Q

Where does the radial nerve originate from?

A

posterior cord (C5-T1)

55
Q

Course of the radial nerve

A
  • lies posterior to axillary artery
  • ducks deep between lat & med heads of triceps brachii
  • travels in radial groove on humerus
  • enters anterior arm between brachioradialis & brachialis (cubital fossa)
  • crosses elbow joint anteriorly & divides
56
Q

Branches of radial nerve

1. deep branch radial/ posterior interosseus nerve

A
  • pierces supinator
  • then runs along posterior surface of interosseus membrane
  • travels into posterior forearm & innervates everything
57
Q

Branches of the radial nerve

2. superficial branch radial

A

only innervates skin & jts

58
Q

Injury of the radial nerve

A
  • fracture of humerus (radial groove)
  • incorrect technique with crutches
  • arcade of Frohse
  • –> entrapment between supinator heads
59
Q

Where does the median nerve originate from

A
  • lateral cord (C5-C7)

- medial cord (C8-T1)

60
Q

Where do median nerve cords unite?

A

anterior to axillary artery

61
Q

Where does the median nerve travel?

A

deep to biceps brachii

62
Q

what muscle does the median nerve travel on top of?

A

brachialis

63
Q

What accessory structure does Median nerve travel deep to?

A

deep to bicipital aponeurosis in cubital fossa

64
Q

What muscle does Med nerve run between

A

between heads of pronator teres

- then deep to FDS

65
Q

what accessory structure does the median nerve travel deep to to enter the hand?

A

the flexor retinaculum via carpal tunnel

66
Q

ulnar nerve originates from:

A

medial cord (root value C8-T1)

67
Q

what muscle does the ulnar nerve travel anterior to?

A

triceps brachii

68
Q

what landmarks does the ulnar nerve travel in between (near elbow)?

A

between the medial epicondyle of the humerus and the olecranon

69
Q

how does the ulnar nerve enter the anterior forearm?

A

by passing through heads of FCU

70
Q

what muscle does ulnar nerve run along lateral to ulnar artery?

A

FDP

71
Q

how does the ulnar nerve enter the hand?

A

by passing anterior to flexor retinaculum just lateral to the pisiform

72
Q

Branch of the median nerve

A

interosseous branch

73
Q

where is the anterior interosseus branch of the median nerve formed?

A

cubital fossa

74
Q

where does the anterior interosseous branch of the median nerve travel?

A

on anterior surface of interosseous membrane

75
Q

injury of the median nerve:

A
  • deep cuts to the forearm
  • superficial cut at wrist
  • entrapment between heads of pronator teres
  • carpal tunnel syndrome
76
Q

injury of ulnar nerve:

A
  • at the groove behind the medial epicondyle
  • superficial cut at wrist
  • fall onto hand/ compression in Guyon’s canal (between hook of hamate & pisiform)
77
Q

SMALLER BRANCHES
Branches from the cords
Lateral pectoral nerve

A

innervates pectoralis major

- from lateral cord

78
Q

BRANCHES FROM THE CORDS

Upper subscapular

A

subscapularis

- posterior cord

79
Q

BRANCHES FROM THE CORDS

Thoracodorsal

A

Lat dorsi

- posterior cord

80
Q

BRANCHES FROM THE CORDS

Lower subscap

A

lower subscapularis & teres minor

- posterior cord

81
Q

BRANCHES FROM CORDS - MEDIAL CORD

A
  1. medial pectoral nerve (pec minor & part of major)
  2. medial cutaneous nerve of Arm
  3. medial cutaneous nerve of forearm
82
Q

BRANCHES FROM THE ROOTS

1. dorsal scapular

A

rhomboids

83
Q

BRANCHES FROM THE ROOTS

2. long thoracic

A

serratus anterior

84
Q

BRANCHES FROM THE TRUNKS

1. suprascapular

A

supraspinatus, infraspinatus (comes from superior trunk)

85
Q

BRANCHES FROM THE TRUNKS

2. nerve to subclavius

A

subclavius (comes from superior trunk)

86
Q

what is the nerve entering corachobrachialis?

A

musculocutaneous nerve

87
Q

nerves of the “M”

A
  1. musculocutaneous
  2. median nerve
  3. ulnar nerve
88
Q

what are the feet of the “m”

A

medial and lateral cords

ANAT102 (9 decks)

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