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NERVES OF THE FOREARM AND HAND LEARNING OBJECTIVES At the end of the lecture, the student should be able to: Describe the innervations to and from the forearm through the brachial plexus. Give us a brief review of the brachial plexus. Know divisions of the nerves supplying the forearm. Know Supra scapular nerves and infra scapular nerves. Know Nerves of the pectoral region. Know Nerves of the hand. INTRODUCTION Innervations to and from the upper limb run through the brachial plexus. It arises from the c4 through t1. It crosses from the base of the neck, axilla before reaching the arm DEVLOPMENT As embryonic so mites migrate to form the limbs, they drag the nerve with them so that each dermatome and my tome retains the original segmental innervations With so mites migration so of the nerves coming close together and fuse in a particular fashion, forming a plexus, and in upper limb it is brachial plexus. BREIF REVIEW OF THE BRACHIAL PLEXUS Formed by the anterior primary ramie of the c4 through t1. The brachial plexus consists of , Roots Trunks Divisions Cords Nerves BRANCHES FROM THE ROOTS Dorsal scapular nerve innervates the rhomboids and levator scapulae. Long thoracic nerve, sarratus anterior. Contribution to the phrenic nerve, which supplies the diaphragm. BRANCHES FROM THE TRUNK Suprascapular, supply the supraspinatious and infraspinatious. Nerve to salacious, supply the subclavious. DIVISIONS No branches from the divisions of the brachial plexus. CORDS OF THE BRACHIAL PLESUS Lateral cord Posterior cord Medial cord LATERAL CORD Lateral pectoral nerve Lateral root of the median nerve Musculocutaneous nerve POSTERIOR CORD Upper suprascapular Lower suprascapular Thoracodorsal Axillary nerve Radial nerve MEDIAN NERVE Medial cutaneous nerve of the arm Medial cutaneous nerve of the forearm Medial pectoral nerve Medial root of the median nerve Ulnar CUTANIOUS NERVES OF THE UPPER LIMB SEGMENTAL INNERVATION OF THE UPPER LIMB MUSCLES NERVES SUPPLYING THE UPPER LIMB ARE DIVIDED INTO THE FOLLOWING GROUPS Supra scapular Infra scapular NERVES OF THE SCAPULAR REGION OR SUPRA SCAPULAR NERVES Dorsal scapular nerve, arises from the fifth cervical ventral ramus, supply the levator scapulae and than the rhomboids major and rhomboid minor. Long thoracic nerve, formed by the roots ot the fifth to seven cervical ventral rami, supplies each division of the serratus anterior. Nerve to subclavius, arise from the junction of the fifth and the sixth cervical rami, it passes above the subclavian artery to supply the subclavius muscle. Supra clavicular nerve, branch of the superior trunk supplies the supraspinitious and infraspinatious muscle. INFRA SCAPULAR NERVES Nerves of the pectoral region Nerves of the arm Nerves of the forearm Nerves of the hand NERVES OF THE PECTORAL REGION Lateral pectoral nerve, larger than the medial and supplies the Pectoralis major by piercing the pectoral fascia. Medial pectoral nerve, supplies the Pectoralis minor and small part of the Pectoralis major. Upper sub scapular supplies the sub scapularis muscle. Lower sub scapular, supplies the sub scapularis Thoracodorsal accompanies the sub scapular artery and supplies the latissimus dorsi. NERVE OF THE ARM Axillary nerve, it arises from the posterior cord, it traverses the quadrangular space, it divides in the space into the anterior and posterior branches. The anterior branch gives supply to the deltoid muscle and the skin orer it. The posterior branch gives supply to the teres minor and the lateral cutaneous nerve of the arm. Musculocutaneous nerve, it arises form the lateral cord; it prices the coracobrachialis and descends laterally between biceps and the brachialis to the lateral skin of the arm. Medial cutaneous nerve of the arm, it is the smallest and most medial branch of the brachial plexus. Supplies the distal third of the arm on medial aspect. Medial cutaneous nerve of the forearm arises from the medial cord and supplies the medial aspect of the forearm. NERVES OF THE FOREARM Ulnar nerve, at the elbow the ulnar nerve is at the dorsum of the medial epicondyle, it enters the forearm between the two heads of the flexor carpi ulnairis superficial to the posterior and oblique part of the ulnar collateral ligament. It gives Articular branches to the elbow joint. Muscular branches of the ulnar nerve, usually two muscular branches, flexor carpi ulnaris and the medial half of the flexor digitorum profundus. Palmer cutanious branch, it arises at the mid of the forearm, it some times supply the pamaris braves. Median nerve enters the forearm between the two heads of the pronator teres. Anterior interosseous nerve, with anterior interosseous artery it descends anterior to the interosseous membrane. Radial nerve, it descends in the arm behind the third part of the axillary artery and upper part of the brachial artery. it passes through the triangulate space with the profunda brachii artery. On reaching the lateral side of the forearm it pierces the lateral intermuscular septum the enters the anterior compartment. In the triangular space it gives the posterior cutanious nerve of the arm. Radial nerve,it desends in the arm behind the third plart of the axillary artery and upper part of the brachial artery.it passes through the triangulat space with the profanda brachii artery. On reaching the lateral side of the forearm it plerices the lateral intermuscular septum the enters the anterior compartment. In the triangular space it gives the posterior cutanious nerve of the arm. It supplies the flesor pollicis longus and lateral part of the flesor digitorium profondus. It supplies all the flesors of the forearm supperfical muscles except the flesor carlpi ulanris, i-e pronstor teres, flaxor carpi radilais, flesor digitorium superfacilis, palamaris longus. RADIAL NERVE Radial nerve,it desends in the arm behind the third plart of the axillary artery and upper part of the brachial artery.it passes through the triangulat space with the profanda brachii artery. On reaching the lateral side of the forearm it plerices the lateral intermuscular septum the enters the anterior compartment. In the triangular space it gives the posterior cutanious nerve of the arm. Branches of the radial nerve in the arm Muscular branches, triceps,anconeus,brachioradilis,extensor carpi radilis longus, brachilis. Cutaneous branches, posterior cutanious nerve, and lateral cutaneous nerve of the arm. Posterior cutaneous nerve of the forearm. Articular branches to the elbow joint. Radial nerve supplies the extensor carpai radilis bravis and the supinator muscle. Posterior interosseous nerve, it is the deep terminal branch of the radial nerve. It supplies the suppinator and the extensor carpi radialis brivis it also, Extensor digitorium, extensor digiti minimi, extensor carpi ulanris. Extensor pollicius longus and extensor indicis Abductor pollicus longus and extensor policis brevis. OF THE HAND Thenar muscles are supplied by median nerve, abductor pollicius brevis, and openness pollicis and part of the flexor policis brevis, part of it is supplied by theulner nerve. The adductor pollicis muscles are supplied by the ulnar nerve. Hypothanar muscles, abductor gigiti minimi Opponens digiti minimi Flexor digit minima all are supplied by the ulnar nerve. Dorsal interosseis and palmer interossei are supplied by ulnar nerve. Numerical muscles are supplied by the , Medial two by the ulnar nerve. Lateral two by the median nerve.