Transcript Nerve Supply of the Upper Limb

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
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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
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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
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Dermatome
Myotome
Cutaneous nerve
Prefixed brachial plexus
Postfixed brachial plexus
Roots
Trunks
Divisions
Cords
Supraclavicular branches
Infraclavicular branches
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Course
Distribution
Carpal tunnel syndrome
Palsy
Paraesthesia
Anaesthesia
Paresis
Paralysis
Erb’s palsy
Klumpke’s palsy