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Nerve Supply of the Upper Limb The Brachial Plexus Learning Outcomes after this session you should be able to… • Describe the basic anatomy and course of the brachial plexus • Describe the distribution of all branches of the plexus • Describe the course of the major nerves and identify where each is vulnerable to injury • Identify the dermatomes of the upper limb • Predict the effects of damage to nerve roots, the plexus and peripheral nerves based on anatomical knowledge ANATOMY OF THE PLEXUS Brachial Plexus Drake et al (2005) Gray’s Anatomy for Students (Publ Elsevier) Brachial plexus in context Ref: Drake et al (2005), Gray’s Anatomy for Students Flash Cards, Elsevier Course of the brachial plexus • Trunks – Emerge between anterior & middle scalenes – Palpable between the clavicle and lower part of the posterior border of SCM • Divisions – Posterior to clavicle, between clavicle & 1st rib • Cords – Lie around the axillary artery; initially between 1st ICS & clavicular ehad of pec major; then between subscapularis & pectoral muscles – Palpable in the axilla Supraclavicular branches • Dorsal scapular n • Long thoracic n (of Bell) • N to subclavius • Suprascapular n Infraclavicular branches • • • • • • Lateral pectoral n Medial pectoral n Superior subscapular n Inferior subscapular n Thoracodorsal n Medial cutaneous n of the arm • Medial cutaneous n of the forearm • • • • • Axillary n Musculocutaneous n Radial n Ulnar n Median n “minor” nerves – know distribution “major” nerves – course & distribution Dermatomes of the upper limb Ref: Gilroy, Mac Pherson & Ross (2008) Atlas of Anatomy Cutaneous Innervation Ref: Gilroy, Mac Pherson & Ross (2008) Atlas of Anatomy Key Words • • • • • • • • • • • Dermatome Myotome Cutaneous nerve Prefixed brachial plexus Postfixed brachial plexus Roots Trunks Divisions Cords Supraclavicular branches Infraclavicular branches • • • • • • • • • • Course Distribution Carpal tunnel syndrome Palsy Paraesthesia Anaesthesia Paresis Paralysis Erb’s palsy Klumpke’s palsy
