14/09/2010

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14/09/2010

Brachial Plexus
By: Chaman Lal Karotia Neurophysiology Trainee, Batch 2010-2012 The Aga University Hospital Karachi.

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Brachial Plexus By: CK 3

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Brachial Plexus By: CK

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BRACHIAL PLEXUS 14/09/2010 Brachial Plexus By: CK 6 .

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Vertebras & Spinal Nerves 14/09/2010 Total 33 vertebras Cervical =07 Thoracic =12 Lumber =05 Sacral =05 Coccygeal =04 Spinal nerves 31 pairs Cervical =08 Thoracic =12 Lumber =05 Sacral =05 Coccygeal =01 Brachial Plexus By: CK 8 .

‡ Flexion/Extension of the cervical spine is at. ± Atlanto-occipital joint 14/09/2010 ‡ Rotation of the cervical spine is at. ± Atlanto-axial joint Brachial Plexus By: CK 9 .

14/09/2010 Vertebral Foramen Atlas (C1) ‡ Intervertebral foramen Sacrum 14/09/2010 Brachial Plexus By: CK 10 .

? ‡ Ventral/Anterior Horn ‡ Lateral Horn ‡ Dorsal/Posterior Horn Ramus ? ‡ Ventral Ramus ‡ Dorsal Ramus Root ? ‡ Ventral Root ‡ Dorsal Root Efferent Nerve .14/09/2010 Terms To Define? Horns in Spinal Cords..? Afferent Nerve ? Spinal Nerve ? Ganglion ? Brachial Plexus By: CK 11 .

14/09/2010 Horns In The Spinal Cord ‡ In the spinal cord the gray matter is present inside and white matter is towards outside while in brain this distribution is vice versa. ‡ On cross section of the spinal cord gray matter in spinal cord presents butterfly like structure form which some projections like Horns are seen termed as:  Ventral/Anterior Horn {Ventral/Anterior/Motor Root Centre}  Lateral Horn {Preganglionic Sympathetic Neurons. its present only in T1-L2}  Dorsal/Posterior Horn {Dorsal/Posterior/Sensory Root Centre} Brachial Plexus By: CK 12 .

fuse within the intervertebral foramen to form a mixed spinal nerve.14/09/2010 Terms To define . Spinal Nerve: ‡ The dorsal and ventral roots. ‡ Dorsal/Posterior/Sensory/Afferent Root: It arises from Dorsal or Posterior horn of the Spinal Cord and carries only sensory fibers. arising from each spinal cord segment. Brachial Plexus By: CK 13 .cont d ‡ Root ‡ Ventral/Anterior/Motor/Efferent Root: It arises from Ventral or Anterior horn of the Spinal Cord and carries only motor fibers.

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rami) The spinal nerve when exits from the vertebrae it divides into two branches termed as. Ventral/Anterior Primary Ramus 2. Brachial Plexus By: CK 15 . ‡ Dorsal/Posterior Ramus: It is the dorsal or posterior division of the spinal nerve out side the vertebrae. It supplies to the skin.g. 1. sympathetic paravertebral ganglion. It supplies to the skin & muscles of the back.cont d 14/09/2010 ‡ Ganglion: Collection of the nerve cell bodies is called Ganglion e. Dorsal Root Ganglion DRG .. ‡ Ramus (Pl.Terms To define . muscles on anterior body & viscera etc. Dorsal/Posterior Primary Ramus ‡ Ventral/Anterior Ramus: It is the ventral or anterior division of the spinal nerve out side the vertebrae.

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C8 . ± The trunks traverse the posterior triangle of the neck. Cervical. ‡ Brachial Plexus has the following relations to the surrounding structures: ± The roots lie between the anterior and middle scalene muscles. and are named according to their relationship with the Axillary artery. ± The divisions lie behind the clavicle.e. ‡ Now these are termed as Ventral/ Anterior Spinal Nerve Roots. T1 spinal nerves.14/09/2010 ‡ All plexus i. Brachial & Lumbo-sacral are formed by the fusion of Ventral or Anterior Primary rami of the spinal nerves. C7 . ‡ Brachial Plexus are formed by anterior primary rami of C5 . Brachial Plexus By: CK 18 . ± The cords lie in the axilla. C6 ..

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7.T1 ‡ Trunks ± Upper ± Middle ± Lower ‡ Divisions ± Anterior ± Posterior ‡ Cords ± Lateral ± Medial ± Posterior 14/09/2010 22 Brachial Plexus By: CK .6.R T D C B OOT RUNK IVISIONS ORDS RANCHES ‡ Nerve Roots ± C5.8.

‡ Trunks : o Upper Trunk: It is formed by the combination of C5 & C6 spinal nerve roots.  The trunks traverse the posterior triangle of the neck. Brachial Plexus By: CK 23 .cont d ‡ Roots : These are constituted by the anterior primary rami of spinal nerves C5 . o Middle Trunk: It is formed by the continuation of the C7 spinal nerve root.14/09/2010 Brachial Plexus . T1 . C6 . o Lower Trunk: It is formed by the combination of the C8 & T1 spinal nerve roots. C8 . C7 ..

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o Medial Cord: It is formed by the continuation of anterior division of Lower Trunk. Brachial Plexus By: CK 25 . Middle & Lower Trunks. 1. Posterior Division  The divisions lie behind the clavicle.Brachial Plexus . ‡ Cords: o Lateral Cord: It is formed by the combination of Anterior divisions of Upper & Middle Trunks.cont d 14/09/2010 ‡ Divisions: Now each trunk give rise to two divisions i.. Anterior Division 2. o Posterior Cord: It is formed by the combination of all three posterior divisions of Upper .e..

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Nerve To Subclavius . Suprascapular Nerve 2. C6 . and are named according to their relationship with the Axillary artery. C6) (C5 . ‡ Branches: ‡ Branches of the Roots: 1. C7 ) (C5 ) (C5 . C6) Brachial Plexus By: CK 27 ‡ Branches of the Trunks: 1. Dorsal Scapular Nerve (C5 ..cont d ‡ The cords lie in the axilla. Long Thoracic Nerve 2.14/09/2010 Brachial Plexus .

14/09/2010 Branches of Brachial Plexus .N. Medial Root of Median Nerve 5. Musculocutaneous Nerve 3. Lateral root of Median Nerve {2LM}  Medial Cord (C8 . Ulnar Nerve {4MU} Brachial Plexus By: CK 28 . 1. C6 . of forearm (Medial Antibrachial Nerve) 4. Medial Cutaneous Nerve of Arm 3.. T1): It gives Five branches. 1.cont d ‡ Branches of the Cords: Lateral Cord (C5 . Medial Cut. C7 ) : It gives Three branches. Lateral pectoral Nerve 2. Medial Pectoral Nerve 2.

T1 ): Upper Subscapular Nerve Lower Subscapular Nerve Thoracodorsal Nerve (Nerve To latissimus dorsi) Axillary Nerve Radial Nerve {2STAR}  Medial Antibrachial Medial Cord  Lateral Antibrachial Continuation of Musculocutaneous Nerve Lateral Cord Brachial Plexus By: CK 29 .14/09/2010 Branches of Brachial Plexus .. C6 . 3. 2. 4. C8 . C7 . Posterior Cord (C5 . 5.cont d  1.

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14/09/2010 Main Terminal Branches ‡ ‡ ‡ ‡ ‡ Musculocutaneous Nerve Axillary Nerve Median Nerve Ulnar Nerve Radial Nerve Brachial Plexus By: CK 31 .

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? Brachial Plexus By: CK 35 .14/09/2010 WHEN TO DO BRACHIAL PLEXUS PROTOCOL?  Primary Physician s Query. .?  Numbness & Pain (radiating/non radiating) etc in arms .?  Erb s Palsy (C5 Root Avulsion) .S) ?  Brachial Plexopathy ?  Brachial Neuritis .O..?  Klumpke s Palsy ?  Trunk or Cord level Injury Query ?  Wrist droop Query . forearms & hands.  Thoracic Outlet Syndrome (T.

Farmer Merk who received the world's first complete double arm transplant is recovering well and able to perform some basic tasks. who lost his own just below the shoulder in a farm accident involving a combine six years ago. 2008 Karl Merk. the world's first person to receive a complete double arm transplant. Doctors spent 15 hours on July 25-26 grafting the donor arms onto the body of 54-year-old Karl Merk.14/09/2010 October 8. It still could take up to two-years until he re-learns how to use his hands. Brachial Plexus By: CK 36 .

then arteries and veins to ensure blood circulation as quickly as possible. Before the bones of the donor could be cut.The bones were joined. The surgeons then attached the muscles and tendons. There had been no sign that Karl s immune system was rejecting the foreign tissue and his scars were healing well. nerves and blood vessels to be connected. Brachial Plexus By: CK 37 .14/09/2010 First they exposed the muscle. Both arms were then removed exactly at the point matching Karl s arm stumps. blood vessels in the teen s arms were filled with a cooled preservation solution. then the nerves and finally the skin.

" said Mr Merk as he showed off the arms.uk/news/worldnews/europe/germany/Worldsfirst-double-arm-transplant-patient-delighted. which are being supported by a special "corset" while the healing continues. Karl can already open a door and turn lights on and off. Every day I gain more mobility.co.telegraph.14/09/2010 "The feeling is indescribable.html Brachial Plexus By: CK 38 . http://www.

html Brachial Plexus By: CK 39 .  ESSENCE (A Review Book of Gross Anatomy) 6th Ed.I By: B.Shapiro 2nd Ed. Dow Promotion Cell Publication.14/09/2010 References:  Snell's Text Book of Anatomy Brachial Plexus 23rd Ed.uk/news/worldnews/europe/germany/ Worlds-first-double-arm-transplant-patientdelighted.  Human Anatomy Upper Limb& Thorax Anatomy Vol.co.  Anatomy & Physiology By: Inderbir Singh.Preston & Barbra E. JP Brothers Publication.telegraph.  Electromyography & Neuromuscular Disorders By David C.  www.D Chaurasia.

14/09/2010 Success doesn t lie in the Results but in the Efforts Being the best is NOT so important Doing the best is all that Matters ! 40 .

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