Majorplexus of nerves supplying the upperlimb whichprovides Brachial Plexus Formed motor sensory sympathetic innervation to the upperlimb Ventral Rami of lowerfour cervical nerves first thoracic nerve 65,06 0768 T1 the by Parts Roots Trunks Divisions Cords Branches Begins in the lowerpart of PosteriorTriangle ofneckjust above the clavicle under the clavicle and to the axilla Tyng Damn T i superior I 6 y 7 my man as Mh T1 MMM M sins anterior Axillary Radial Nerve Anterior Medial Posterior I LongthoracicNerve Infrasupraspindaticiuperior I kkk df Branchesfromthe Roots CS Cle 07 Dorsal ScapularNerve Nerveto Rhomboids g BranchesfromtheTrunk Medial Cord Branches UlnarNerve CS T1 medial pectoralNerve 08 T't AxillaryNerve CS C6 UpperSubscapular CS LowerSubscapular 6 Musculocutaneous Nerve 05 C Lateral Pectoral Nerve CS Ch Lateral Root of MedianNerve Cs 8 T1 Innervation Thoracodorsal Nerveto latissimusDorsi 6,27 C8 MotorFunction BicepsTendon ShoulderAbduction Extension External Rotation Someelbowflexion Brachio radialis ElbowFlexion ForearmPronation Supination somewristextension Triceps Diffusefunctionin the extremity None Wristflexors fingerFlexorsExtensors intrinsicmuscles of hand intrinsicmuscles of hand None Segmental Innervation for UpperLimb Movements 05 Abduction 6 Adduction Elbow CubitalJoint CS Cle Flexion BicepsJerk is Nerves iii Branchesfrom LateralCord C6 C7 Interiorstisiapular Branches of PosteriorCord Branchesfromthe cords Reflex thoracodorsal MedialCutaneousNerveofArm MedialCutaneousNerveof forearm Nerve to Subclavius SuprascapularNerve 5 66 C5 UlnarNerve MedialPectoralMedialCutaneousNerveofArmMedialCutaneousNerveof forearm LongThoracic Nerve Nerve to SerratusAnterior RootLevel t de f subscapular DorsalScapularNerve were MedianNerve t Inferior1 nd p I 1 warNerve Anterior Posterior Middle i lateral 1 Posterior continues downward 6807 Flexion Extension Knuckles Metacarpophalangeal Joints TI Abduction Adduction offingers Erb's Duchenne Syndrome Palsy Site of Injury Superiortrunk of Brachial Plexus Causes Birthinjuries fall on shoulder in whichhead NerveRoot shoulder areforcefullyseparated CS Cle Suprascapular Nerve AxillaryNerve Musculocutaneous Nerve SAM MusclesParalysed Deltoid Supraspinatus TeresMinor Infraspinatus AnteriorCompartmentofArm WristExtensor Deformity Waiter'sTipDeformity Disability lossof Abduction Lateral Rotation ofShoulder Flexion atElbow partofSupination Klumpke's Palsy Site of Injury InferiorTrunkof Brachial Plexus Causes Birthinjuries or injurywhenupperlimb ispulledupward awayfrombody NerveRoot C8 T1 UlnarNerve MedialCutaneous NerveofArm MedialCutaneousNerveofforearm RadialNerve partialmedian nerve Muscles Paralysed IntrinsicMusclesofhand innervatedbyUlnarNerve Deformity Total ClawHand Radial Nerveinjury wrist drop A 32-year-old man gave a Hx of fall from the roof top, and he landed on his right shoulder with a forceful stretch on his neck. Following which he complained of inability to abduct his shoulder and bend his elbow. Which part of the nervous system would be a ected. W Answer: Upper trunk of Brachial Plexus of Upper Limb Peripheral Nerves a yes AxillaryNerve Course Injury Arisesfrom Posteriorcordof BrachialPlexus passesthrough axilla and winds around theneck of humerus Musclessupplied it Deltoid TeresMinor CausesofInjury Shoulderdislocation fracture ofsurgical neck of humerus compression on the axilla crutches abduction Disability loss of lossof sensation overlateralpartof by shoulder SuprascapularNerve Injury CS CleC7 Course ArisesfromUpperTrunkof BrachialPlexus MusclesSupplied it Supraspinatus Infraspinatus by Causes Entrapment in Supra scapularforamen of Scapula Disability Difficultyto initiateabduction weakness in LateralRotation there Insury leadsto winged scapula Musculocutaneous NerveInjury C5 C6 Course ArisesfromLateralcord of Brachial Plexus MusclesSupplied it Biceps Brachii Brachialis Coraco Brachialis by Causes Injury tothe Axilla EntrapmentbyCoraco Brachialis muscle Disability Loss offlexion at Elbo supination sensoryloss on lateralside of forearm LongThoracicNerve Nerveof SerratusAnterior Course Arisesfromroots of BrachialPlexus 5 07 of axilla alongthemedialwall of thorax MusclesSupplied descendsthrough the apex Serratus Anterior Causes Carryingheavyloadonshouldersuddenpressurefrom above Deformity Wingingofscapula Disability weakness in overheadabduction protraction UlnarNerve C8 T1 Course Descendsdown the Medialsideof arm posteriorly to medialEpicondyle of Humerus then runs along themedialsideof the forearmunder the Flexor CarpiUlnaris Muscles Supplied entersthe hand superficially to flexorRetinaculum flexorDigitorum Profundis medial half lumbricals Hand Interossei two hypothenarmuscles AdductorBrevis SitesofInjury MedialEpicondyleof Humerus Medialsideof CarpalTunnel guyon's Forearm Flexor CarpiUlnaris Canal fracture of hookof hamate Disability ClawHandDeformity Lossof AbductionAdduction ofDigits flex MCPjoint Inabilityto extend interphalangeal Sensorylossfromthedorsal palmar surfaces ofthemedialone halfthedigits ofthehand RadialNerve ArisesfromPosteriorCordofBrachialPlexus CS T1 Course Passesthrough theRadialGroove of Humerus crosses the cubitalfossa divides inthe SupinatorMuscle toformSuperficial DeepBranch Posterior InterosseusNerve Muscles Supplied Arm Triceps Anconeus Elbow ExtensorCarpiRadialisLongis Brachioradialis Forearm All extensormusclesofwrist fingers PosteriorInterosseousNerve SitesofInjury Compression inAxilla FractureofHumeralShaft SupinatorEntrapment Deformity Wristdrop Disability LossofExtension ofElbow wrist MPjoints Sensoryloss of PosteriorPartof arm forearm dorsum ofhand three halffingers MedianNerve Arisesfromlateral Medialcordof BrachialPlexus CS T1 Course RunsdownmedialsideofArm crosseselbowanteriorly thenrunsbetweenthetwo headsof Pronatorteres enters deepto Carpaltunnel terminates in thehand Musclesinforearm Allflexors exceptFCU FDP medialhalfbleAnterior InterosseousNerve Musclesin HandThenarmuscles exceptAdductorPollicis alsosupplies Lumbricals 1 2 SitesofInjury Supra condylarfractureofHumerus In thecubitalfossa CarpalTunnelSyndrome PronatorTeresSyndrome Deformity ApeThumbDeformity HandofBenediction Disability Lossofflexioninwrist fingers thumb Sensorylossof lateralthree halffingers A 27-year-old man is admitted to the emergency department after a car crash. Physical exam reveals weakness in medial rotation and adduction of the humerus. Which of the following nerves are most probably injured from this case? • Thoracodorsal • Axillary • Dorsal Scapular • Spinal Accessory • Radial Brachial Plexus 1. Draw and label the brachial plexus without any errors to include its roots, trunks, divisions, cords, and nerves. 2. During the interpretation of a clinical scenario of a patient with a dislocated shoulder provide the nerves that need to be examined and the physical examination skill that examines each nerve. 3. When provided with a nerve lesion to either the root, upper, middle or lower trunk, or cord provide the clinical ndings. 4. Di erentiate based on clinical signs and symptoms between injuries to the radial, ulnar, median, thoracodorsal, axillary, and musculocutaneous nerves. Once you have di erentiated su ciently from the symptoms and exam ndings provide an accurate diagnosis. 5. Provide the name of the muscular structure responsible for thoracic outlet syndrome. In addition provide the bony structure that may cause the same type of symptoms. 6. Wrist drop can be caused by injury/trauma to the axilla or by direct injury to the radial nerve. From a case scenario correctly provide a diagnosis of radial groove involvement of this structure during distal 1/3 humeral fractures.
