Download Brachial Plexus Injuries

Brachial Plexus
Dr. Sama-ul-Haque
Dr. Nivin Sharaf
BRACHILAL PLEXUS
• The brachial plexus is a somatic nerve plexus formed by
intercommunications among the ventral rami of the lower four
cervical nerves ( C 5 - C 8) and the first thoracic nerve (T
1). The plexus is responsible for the motor innervation to all of
the muscles of the upper limb with the exception of the
trapezius and levator scapula.), and the sensory innervation of
the upper limb except an area just above the point of the
shoulder (supplied by supraclavicular nerves) and the dorsal
scapular area which is supplied by cutaneous branches of
dorsal rami.
Spinal Nerve
FORMATION OF THE BRACHIAL PLEXUS
• Roots
– The ventral rami of spinal nerves C5 to T1 are referred to as the
roots of the plexus.
• Trunks
– Shortly after emerging from the intervertebral foramina , these 5
roots unite to form three trunks.
– The ventral rami of C5 & C6 unite to form the Upper Trunk.
– The ventral ramus of C 7 continues as the Middle Trunk.
– The ventral rami of C 8 & T 1 unite to form the Lower
Trunk.
• Divisions
– Each trunk splits into an anterior division and a posterior division.
– The anterior divisions usually supply flexor muscles
– The posterior divisions usually supply extensor muscles
Location of Brachial plexus
Relations of Brachial plexus
FORMATION OF THE BRACHIAL PLEXUS
CONT.
• Cords
– The anterior divisions of the upper and middle trunks unite to form
the lateral cord.
– The anterior division of the lower trunk forms the medial cord.
– All 3 posterior divisions from each of the 3 cords all unite to form the
posterior cord.
•
The cords are named according to their position relative to the axillary artery
• Terminal branches:
•
•
•
•
•
Musculo Cutaneous
Ulnar n.
Median n.
Axillary n.
Radial n.
Relations of Brachial plexus
Brachial Plexus
Relation with Axillary Artery
Postfixed Brachial Plexus
Brachial Plexus Injuries
•
The brachial plexus lies in the posterior
triangle of the neck between the scalenus
anterior and scalenus medius muscles. At the
root of the neck, it lies behind the clavicle.
• The most common injury is severe traction with
the arm in abduction e.g. after a motor cycle
accident. Partial paralysis may also result from
shoulder dislocation. Direct injury to the
brachial plexus can result from a stab or
gunshot wound.
:
Brachial Plexus Injuries
• In Adults:
• Sports most commonly associated:
Football, baseball, basketball,
volleyball, wrestling, and
gymnastics.
• Nerve injuries can result from:
Blunt force trauma, poor posture or
chronic repetitive stress.
Brachial Plexus Injuries
• Patients generally present with
pain and/or muscle weakness.
• Some patients may experience
muscle atrophy.
Brachial Plexus Injuries
Result:
 Anesthesia
 Paralysis
1. Complete
2. Incomplete
Erb- Duchenne palsy
Injury to Superior part of Plexus.
Occurrence:
Due to excessive increase in the angle
between neck and the shoulder.
Roots Involved:
 C5 and C6
Muscles Involved:
 Shoulder
 Arm
Vacuum Extractor delivery
Forceps delivery
Falling on
Shoulder
Excessive Stretching
Direct Blow
What is
Waiter’s tip or
Porter’s tip
position?
Erb- Duchenne palsy
Clinical Appearance:
Motor Loss:
 Adducted Shoulder
 Medially Rotated Arm
 Extended Elbow
Sensory Loss:
Lateral aspect of Upper Limb (uncommon)
Waiter’s tip position
• Characteristic position - adduction and
internal rotation of the arm with forearm
pronated
• Forearm extension normal
• Biceps reflex absent
Waiter’s tip palsy
• Erb's palsy is caused by damage to the
brachial plexus during delivery of the
neonate. This is mostly limited to the 5th
and 6th cervical nerves
klumpke paralysis or Palsy
Injury to Inferior part of Plexus.
Occurrence:
Excessive abduction of arm.
Less common then Injury to Superior part of
Plexus.
Roots Involved:
 C8 and T1
klumpke paralysis or Palsy
Clinical Appearance:
Motor Loss:
 Small muscles of Hand
Sensory Loss:
 Medial aspect of Upper Limb
Person grasping something to prevent a fall
Baby’s upper limb is pulled excessively during
delivery
Claw Hand
Aetiology:
brachial plexus lesion (C8T1),Ulnar, and/ or Median
nerve injury
This occurs when all
fingers are clawed. It is the
result of hyperextension at
the metacarpophalangeal
joints and flexion of the
interphalangeal joints.
Claw
Hand
Cervical
Rib
Involves
Inferior part
of Plexus
References
• http://www.upstate.edu/cdb/education/gr
ossanat/limbs2.shtml
• www.medicalstudent.com
• www.netteranatomy.com
Thank You