brachial plexus by ck 2010

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Brachial Plexus

By: Chaman Lal Karotia Neurophysiology Trainee, Batch 2010-2012

The Aga University Hospital Karachi.

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Vertebras & Spinal Nerves

Total 33 vertebras

Cervical = 07Thoracic = 12

Lumber = 05

Sacral = 05

Coccygeal = 04

Spinal nerves 31 pairsCervical = 08

Thoracic = 12Lumber = 05

Sacral = 05

Coccygeal = 01

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Flexion/ Extension of the cervi ca l spine is a t;

At lan t o-occipi t al join t

Rot a tion of the cervi ca l spine is a t;

At lan t o-axial join t

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Intervertebral foramen

Atlas (C1)

Vertebr a l Foram en

Brachial Plexus By: CK

Sacrum

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Terms To Define?

Horns in Spin a l Cords..?Ventr a l/ Anterior HornLater a l Horn

Dors a l/ Posterior HornRoot ?

Ventr a l RootDors a l Root

Spin a l Nerve ?

Ganglion ?

Ramu s ?Ventr a l Ramu s

Dors a l Ramu s

Efferent Nerve .?

Afferent Nerve ?

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H orns In The Spinal CordIn t he spinal cord t he gray ma tt er is presen t insideand whi t e ma tt er is t owards ou t side while in braint his dis t ribu t ion is vice versa.On cross sec t ion of t he spinal cord gray ma tt er inspinal cord presen t s bu tt erfly like s t ruc t ure formwhich some projec t ions like H orns are seen t ermedas:Ventral/Anterior Horn {Ven t ral / An t erior /M o t or Roo tCen t re}Lateral Horn {Preganglionic Sympa t he t ic Neurons; i t spresen t only in T1-L2}Dorsal/Posterior Horn {Dorsal / Pos t erior /S ensory Roo tCen t re}

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Ter m s To define . cont d

RootVentr a l/ Anterior/Motor/ Efferent Root:

It arises from Ven t ral or An t erior hornof t he Spinal Cord and carries only mo t or fibers.

Dors a l/ Posterior/ Sensory/ Afferent Root:It arises from Dorsal or Pos t erior horn

of t he Spinal Cord and carries only sensory fibers.

Spin a l Nerve:The dorsal and ven t ral roo t s, arising from each spinalcord segmen t , fuse wi t hin t he in t erver t ebral forament o form a mixed spinal nerve.

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Ter m s To define . cont d

Ganglion: Collec t ion of t he nerve cell bodies is calledG anglion e.g., Dorsal Roo t G anglion DRG , sympa t he t ic

paraver t ebral ganglion.Ramu s (Pl. ram i)

The spinal nerve when exi t s from t he ver t ebrae i t dividesin t o t wo branches t ermed as;

1 . Ven t ral / An t erior Primary Ramus2 . Dorsal / Pos t erior Primary Ramus

Ventr a l/ Anterior Ramu s:It is t he ven t ral or an t erior division of t he

spinal nerve ou t side t he ver t ebrae. I t supplies t o t he skin,

muscles on an t erior body & viscera e t c.Dors a l/ Posterior Ramu s:

It is t he dorsal or pos t erior division of t hespinal nerve ou t side t he ver t ebrae. I t supplies t o t he skin &muscles of t he back.

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All plexus i.e., Cervical, Brachial & Lumbo-sacral areformed by t he fusion of Ven t ral or An t erior Primaryrami of t he spinal nerves.B rachial Plexus are formed by an t erior primary rami of C5 , C6 , C7 , C8 , T 1 spinal nerves .

Now t hese are t ermed as Ven t ral / An t erior Spinal NerveRoo t s.Brachial Plexus has t he following rela t ions t o t hesurrounding s t ruc t ures:

The roo t s lie be t ween t he an t erior and middle scalenemuscles.

The t runks t raverse t he pos t erior t riangle of t he neck. The divisions lie behind t he clavicle. The cords lie in t he axilla, and are named according t o

t heir rela t ionship wi t h t he Axillary ar t ery.

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Nerve Roots C5 ,6 ,7 ,8 ,T1

Trunks U pper M iddle Lower

Divisions An t erior Pos t erior

Cords La t eral Medial Pos t erior

R OOT

T RUNK

D IVISIONS

C ORDS

B RANCHES

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Brachial Plexus ..con t d

Roots : These are cons t it u t ed by t he an t eriorprimary rami of spinal nerves C5 , C6 , C7 , C8 , T 1 .

Trunks :o Upper Trunk: It is formed by t he combina t ion of

C5 & C6 spinal nerve roo t s.o Middle Trunk: It is formed by t he con t inua t ion of

t he C7 spinal nerve roo t .

o Lower Trunk: It is formed by t he combina t ion of t heC8 & T 1 spinal nerve roo t s.The t runks t raverse t he pos t erior t riangle of t heneck.

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Divisions:

Now each t runk give rise t o t wo divisions i.e.,1 . An t erior Division2. Pos t erior Division

The divisions lie behind t he clavicle.Cords:o Later a l Cord: It is formed by t he combina t ion of An t erior

divisions of Upper & Middle Trunks .o Medi a l Cord: It is formed by t he con t inua t ion of an t erior

division of Lower Trunk .o Posterior Cord: It is formed by t he combina t ion of all t hree

pos t erior divisions of Upper , Middle & Lower Trunks.

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The cords lie in t he axilla, and are named accordingt o t heir rela t ionship wi t h t he Axillary ar t ery.

Branches:Branches of the Roots:1 . Long Thoracic Nerve (C5 , C6 , C7 )2 . Dorsal Scapular Nerve (C5 )

Branches of the Trunks:

1 . Suprascapular Nerve (C5 , C6)2 . Nerve To Subclavius (C5 , C6)

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Branches of Brachial Plexus ..con t d

Branches of the Cords:Lateral Cord (C5 , C6 , C7 ) : It gives Three branches;1 . La t eral pec t oral Nerve2. M usculocu t aneous Nerve

3. La t eral roo t of Median Nerve {2LM}M edial Cord (C 8 , T 1 ): It gives Fiv e branches;

1 . Medial Pec t oral Nerve2. M edial Cu t aneous Nerve of Arm3. M edial Cu t .N. of forearm ( Medial An t ibrachial Nerve)4. M edial Roo t of Median Nerve5. Ulnar Nerve {4M U}

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Branches of Brachial Plexus ..con t d

Posterior Cord (C5

, C6

, C7

, C8

, T 1 ):1 . U pper Subscapular Nerve2 . Lower Subscapular Nerve

3. T horacodorsal Nerve (Nerve To la t issimus dorsi)4. Axillary Nerve5. Radial Nerve {2STAR}

Medial An t ibrachial Medial CordLa t eral An t ibrachial Con t inua t ion of Musculocu t aneous Nerve La t eral Cord

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Main Terminal Branches

Musculocu t aneous NerveAxillary Nerve

Median NerveUlnar Nerve

Radial Nerve

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W HE N TO DO BRACH IAL PLEXU S PROTOCOL?

Primary Physician s Query. .. ?Numbness & Pain (radia t ing / non radia t ing) e t c inarms , forearms & hands.

Thoracic Ou t le t Syndrome ( T.O.S) ?Brachial Plexopa t hy ?Brachial Neuri t is . ?Erb s Palsy ( C5 Roo t Avulsion) . ?Klumpke s Palsy ?Trunk or Cord level Injury Query ?W ris t droop Query . ?

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Oc t ober 8 , 2008Karl Merk, t he world's

firs t person t o receive acomple t e double armt ransplan t .

Fa rm er Merk who re ceived theworld's first com plete do uble a rmtr anspl ant is re covering well andable to perfor m so m e b asic tasks. Itstill cou ld take up to two-ye a rs untilhe re-le a rns how to use his h ands.Doctors spent 1 5 ho urs on J u ly 25-26gra fting the donor a rm s onto thebody of 54-ye a r-old Ka rl Merk , wholost his own j ust below the sho u lderin a f a rm acc ident involving acom bine six ye a rs ago.

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First t hey exposed t he muscle, nerves and blood vessels t o be connec t ed.Before t he bones of t he donor could be cu t , blood vessels in t he t een s arms

were filled with a cooled preserva

tion solu

tion. Bo

th arms were

thenremoved exac t ly a t t he poin t ma t ching Karl s arm s t umps. The bones were

joined, t hen ar t eries and veins t o ensure blood circula t ion as quickly aspossible. The surgeons t hen a tt ached t he muscles and t endons, t hen t henerves and finally t he skin. There had been no sign t ha t Karl s immune sys t emwas rejec t ing t he foreign t issue and his scars were healing well.

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h tt p: // www. t elegraph.co.uk / news / worldnews / europe / germany / W orlds-firs t -double-arm- t ransplan t -pa t ien t -deligh t ed.h t ml

"The feeling is indescribable. Every day I gain more mobili t y," said Mr Merk as he showedoff t he arms, which are being suppor t ed by a special "corse t " while t he healing con t inues.Karl can already open a door and t urn ligh t s on and off.

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R eferences:

Snell's Tex t Book of Ana t omy Brachial Plexus 23 rd Ed.H uman Ana t omy U pper Limb& Thorax Ana t omy

Vol.I By: B.D Chaurasia.Ana t omy & Physiology By: Inderbir Singh,

JP Bro t hers Publica t ion.ESSENCE (A Review Book of G ross Ana t omy)

6 t h Ed. Dow Promo t ion Cell Publica t ion.Elec t romyography & Neuromuscular Disorders By David

C.Pres t on & Barbra E .Shapiro 2nd Ed.www. t elegraph.co.uk / news / worldnews / europe / germany /W orlds-firs t -double-arm- t ransplan t -pa t ien t -deligh t ed.h t ml

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Succ ess doesn t l i e i n the Res u lts bu t i n the Efforts

Be i ng the b est i s NOT so imp ortant D o i ng the b est i s all that Matters !

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brachial plexus by ck 2010

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