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Brachial plexus Lufukuja G. 1 Brachial plexus • The brachial plexus is a major network of nerves supplying the upper limb. It begins in the lateral cervical region (posterior triangle) and extends into the axilla. • The brachial plexus is formed by the union of the anterior rami of the (C5-8) and T1 nerves, which constitute the roots of brachial plexus • The roots usually pass through the gap between the anterior and the middle scalene muscles with the subclavian artery. • The sympathetic fibers carried by each root of the plexus are received from gray rami of the middle and inferior cervical ganglia as the roots pass between the scalene muscles. Lufukuja G. 2 Lufukuja G. 4 G.LUFUKUJA 5 Brachial plexus… • In the inferior part of the neck, the roots of the brachial plexus unite to form three trunks : A superior trunk, from the union of the C5 and C6 roots. A middle trunk, which is a continuation of the C7 root. An inferior trunk, from the union of the C8 and T1 roots. Lufukuja G. 6 Brachial plexus… • Each trunk of the brachial plexus divides into anterior and posterior divisions as the plexus passes through the cervicoaxillary canal posterior to the clavicle. • Anterior divisions of the trunks supply the anterior (flexor) compartments of the upper limb, and posterior divisions of the trunks supply the posterior (extensor) compartments of the upper limb. Lufukuja G. 7 Brachial plexus… • The divisions of the trunks form three cords of the brachial plexus, within the axilla: Anterior divisions of the superior and middle trunks unite to form the lateral cord. Anterior division of the inferior trunk continues as the medial cord. Posterior divisions of all three trunks unite to form the posterior cord. Lufukuja G. 8 Cords Give off Branches!! (in axilla) LATERAL CORD LATERAL PECTORAL NERVE MUSCULOCUTANEOUS LATERAL ROOT OF MEDIAN NERVE MEDIAL PECTORAL NERVE MEDIAL CORD MEDIAL ROOT OF MEDIAN NERVE MEDIAL CUTANEOUS NERVE OF ARM MEDIAL CUTANEOUS NERVE OF FOREARM ULNAR NERVE UPPER SUBSCAPULAR POSTERIOR CORD THORACODORSAL LOWER SUBSCAPULAR AXILLARY NERVE RADIAL NERVE G.LUFUKUJA 9 Lufukuja G. 10 APPLIED ANATOMY ERB’S PARALYSIS: Site of injury: Upper Trunk of Brachial plexus Cause of injury: Undue separation of the head from shoulder Nerves roots involved: C5 – C6 Muscles paralysed: Biceps, Deltoid, Brachialis & Brachioradialis. Partly supraspinatus, infraspinatus and supinator The deformity is known as waiter's tip hand or Porter’s tip paralysis G.LUFUKUJA 11 ERB’S PARALYSIS Lufukuja G. 12 Fractures & nerves involved G.LUFUKUJA 13