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Prof.Dr. U.Murali.M.S;MBA
Dept.Of Surgery
D Y Patil Medical College
Mauritius.
Contents of Discussion
Spinal Nerves
Nerve Plexus
BP Origin & Relations
Formation
Parts of BP
Distribution - Nerve Supply areas
Anatomical Variations
Applied Anatomy
Spinal Nerves
Dorsal root
Ventral root
Spinal Nerves
31 pair
Spinal Nerves
8 pairs of cervical
nerves from C1 to C8
12 pairs of thoracic
nerves from T1-T12
5 pairs of lumbar nerves
from L1 to L5
5 pairs of sacral nerves
from S1 to S5
1 pair of coccygeal
nerves located at C zero
(Co)
Formation of Rami
12-6
Nerve Plexuses
Nerve plexus
12-7
Branches
of
Spinal
Nerves
Dorsal Ramus
12-8
12-9
Major nerves
Axillary
Radial
Musculocutaneous
Ulnar
Median
Brachial Plexus
Relations - BP
Relations - BP
When it emerges
between the Scalene
anterior and medius
--* its upper part lies
above the third part of
the subclavian artery,
* while the trunk
formed by the union of
C8 & T1 is placed
behind the artery.
Relations - BP
Relations
ROOTS
TRUNKS
DIVISION
CORDS
BRANCHES - Roots
Roots
BRANCHES OF UPPER
TRUNK
NERVE TO SUBCLAVIUS
Root value C5,C6
SUPRASCAPULAR
NERVE
Root value C5,C6
Branches LC & MC
LATERAL PECTORAL NERVE MEDIAL PECTORAL NERVE
Root value- C5,C6,C7
Lateral Cord
Direct branches:
Lateral pectoral nerve: C5-7
To clavicular head of pectoralis
major muscle
Terminal nerves:
Musculocutaneous: C5-7
Lateral root of median
nerve: C5-7
MEDIAL
CUTANEOUS
NERVE OF
ARM
Root value- C8,T1
MEDIAL
CUTANEOUS
NERVE OF
FOREARM
Root value C8,T1
Ulnar C8-T1
Medial root of
median nerve C8-T1
ULNAR NERVE
Thoracodorsal nerve:
C6-7
To latissimus dorsi muscle
UPPER
SUBSCAPULAR
Root value-C5,C6
LOWER
SUBSCAPULAR
Root value- C5,C6
NERVE TO
LATISSIMUS DORSI
Root value-C6,C7,C8
AXILLARY NERVE
Motor:
Posterior compartments of
arm and forearm.
Brachioradialis muscle
Sensory:
Back of arm, forearm, hand
RADIAL NERVE
Cutaneous distribution
Anatomic Variations
APPLIED ANATOMY
Divide into :
Klumpkees Palsy
Erbsparalysis
C5 -C6
Birth injury / Trauma
Arm hangs by the side
+ Rotate medially
Forearm pronated +
extended
Flexed wrist + fingers
Deltoid/supraspinatus/
infraspinatus/biceps/
brachialis
. LOS in arm
Klumpkesparalysis
C8 T1
Traction injuries / Fall
* Intrinsic muscles of the hand +
long flexors of the wrist & hand
paralysed
Claw hand = extension at MPJ +
flexion at IPJ ( wrist & hand )
* Forearm supinated
* LOS medial side - am
Cervical rib can cause paralysis
similar to Klumpkesparalysis with
post-fixed T2 contribution
Axillary approach
Draw arches.
Cords
Branches
Begin labeling.
C5
Roots
Trunks
C6
C7
Upper
C8
T1
Middle
Lower
Medial
Posterior
Cords
Lateral
Divisions
Branches
Musculocutaneous
SLOW
Axillary
Median
Radial
Ulnar
Add details . . .
Branches off the posterior cord spell ULTRA
C5
C6
C7
C8
Roots
Trunks
Upper
T1
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Posterior
Cords
Lateral
Divisions
Branches
Musculocutaneous
SLOW
SLOW
Axillary
Median
Radial
Ulnar
C6
C7
C8
T1
Roots
Trunks
Middle
Upper
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Posterior
Cords
Lateral
Divisions
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
Branches
Musculocutaneous
SLOW
SLOW
Axillary
Median
Radial
Ulnar
C6
C7
C8
T1
Roots
Trunks
Upper
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Lateral pectoral n.
Posterior
Cords
Lateral
Divisions
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
Branches
Musculocutaneous
Axillary
Median
Radial
Ulnar
C6
C7
C8
T1
Roots
Long
Thoracic n.
Dorsal Scapular n.
Trunks
Upper
N. to subclavius
Suprascapular n.
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Lateral pectoral n.
Posterior
Cords
Lateral
Divisions
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
Branches
Musculocutaneous
SLOW
Axillary
Median
Radial
Ulnar
Thats it!
C6
C7
C8
T1
Roots
Long
Thoracic n.
Dorsal Scapular n.
Trunks
Upper
N. to subclavius
Suprascapular n.
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Lateral pectoral n.
Posterior
Cords
Lateral
Divisions
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
Branches
Musculocutaneous
Axillary
Median
Radial
Ulnar