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Anatomy - MSK (UL) > 5: Brachial Plexus > Flashcards

5: Brachial Plexus Flashcards

1
Q

How is brachial plexus formed?

A

It is formed by ventral rami of lower four cervical and first thoracic nerves (C5, 6, 7, 8 and T1).

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2
Q

Pre-fixed condition of brachial plexus

A

Contribution from C4 nerve constitutes ‘pre-fixed condition’ of the brachial plexus with reduced T1 contribution. (Shift up)
So C4-C8

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3
Q

Post-fixed condition of brachial plexus

A

Contribution from T2 nerve constitutes post-fixed condition of the brachial plexus with reduced C5 contribution. (Shift down) so C6-T2

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4
Q

Parts of brachial plexus and their locations

A

Parts: roots, trunks, divisions, cords, branches

  1. Supraclavicular part (In the Posterior triangle of neck): roots, trunks, divisions
  2. Infraclavicular part (In the axilla): cords, branches
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5
Q

What part of brachial plexus is first affected in case of clavicle fracture?

A

Superior trunk

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6
Q

C5-T1 (all parts of brachial plexus) contribute to this.

A

Posterior cord + radial nerve

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7
Q

According to what are the cords in brachial plexus named?

A

Named in relation to axillary artery (posterior, medial, or lateral to it)

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8
Q

What nerves are branches from ROOTs?

A
  1. Nerve to serratus anterior (long thoracic nerve) (C5, C6, C7)
  2. Nerve to rhomboideus (dorsal scapular nerve) (C5)
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9
Q

What nerves are branches from UPPER TRUNK?

A
  1. Supra scapular nerve (C5, C6)
  2. Nerve to subclavius (C5, C6)
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10
Q

What’s Erb’s point?

A

Upper trunk of the brachial plexus where six nerves (C5 and C6 roots, nerve to subclavius and suprascapular nerve, anterior and posterior divisions of upper trunk) meet is called Erb’s point.

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11
Q

What nerves branches from the LATERAL CORD?

A
  1. Lateral pectoral nerve (C5, C6, C7)
  2. Musculocutaneous nerve (C5, C6, C7)
  3. Lateral root of the median nerve (C5, C6, C7)

Remember: Lilly loves me

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12
Q

What nerves branches from the MEDIAL CORD?

A
  1. Medial root of the median nerve (C8, T1)
  2. Medial pectoral nerve (C8, T1)
  3. Medial cutaneous nerve of the arm (C8, T1)
  4. Medial cutaneous nerve of the forearm (C8, T1)
  5. Ulnar nerve (C7, C8, T1)

Remember: Miss muneerah makes me unhappy

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13
Q

What nerves branches from the POSTERIOR CORD?

A
  1. Upper subscapular nerve (C5, C6)
  2. Lower subscapular nerve (C5, C6)
  3. Nerve to latissimus dorsi/Thoracodorsal nerve (C6, C7, C8)
  4. Axillary nerve (C5, C6)
  5. Radial nerve (C5, C6, C7, C8, T1)

Remember: ULTRA

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14
Q

What’s Erb’s paralysis (Erb-Duchenne’s palsy) ?

A
  • It is an injury to the Erb’s point results in paralysis of muscles of the upper limb supplied by C5 and C6 fibres.
  • All the muscles supplied by C5 and C6 fibres are affected.
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15
Q

Causes of Erb’s paralysis?

A

Causes of injury include:
1- birth injury (excessive stretching of upper trunk)
2- fall on the shoulder or during anesthesia (brachial plexus block)

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16
Q

Policeman’s tip or Waiter’s tip hand is seen in …?

A

Erb’s paralysis (Erb-Duchenne’s palsy)

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17
Q

What’s Klumpke’s paralysis ?

A

It occurs due to injury to the lower trunk of the brachial plexus (C8, T1).
C8 = medial forearm
T1 = medial arm

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18
Q

Causes of Klumpke’s paralysis ?

A

Causes of injury includes:
1- undue abduction of arm (as in clutching something with hands while falling from a height)
2- presence of cervical rib or birth injury/breech presentation.

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19
Q

What hand movements are lost in klumpke’s paralysis?

A

small intrinsic muscles are responsible for (flexion at the metacarpophalangeal joint and extension at the interphalangeal joints), these movements at the hand are lost.

The opposite movement is exaggerated (hyperextended at metacarpophalangeal joints and hyper flexed at inter phalangeal joints - CLAW HAND)

20
Q

What’s the difference between between klumpke’s claw and ulnar claw

A
  • Klumpke = total claw hand (C8, T1)
  • Ulnar claw = partial claw hand (index & thumb are less affected)
21
Q

Injury to long thoracic nerve leads to..?

A

paralysis of serratus anterior muscle, which is manifested by backward projection of scapula (winging of scapula).

Note: serratus protract (this action is lost), so the rhomboids take over they do the opposite (they retract) thus patient presents with winging

22
Q

What causes long thoracic nerve injury?

A

Long thoracic nerve may be injured while removing the lymph nodes of the axilla.

23
Q

What muscles lose their function in case of Erb’s paralysis?

A

Deltoid, Biceps brachii, Supraspinatus, Supinator, Teres minor, Infraspinatus. (No Abduction/ No lateral rotation/ No forearm flexion, No supination/ No wrist extension)

Remember: don’t be sorry treat it

24
Q

Brachial plexus nerve block is done by injecting anesthetic into (1)? What’s the position of patient’s arm (2)? Doctor should be careful not to injure (3)?

A

1- axillary sheath
2- abducted and laterally rotated
3- axillary artery & branches of brachial plexus

25
Q

What causes Horners syndrome?

A

Involvement of ventral ramus of T1 or its white ramus communicantes causes Horner’s syndrome. (Read attached slide)

26
Q

مالي خلق اقرا و افجج السلايدة :)
“ Cervical rib syndrome/Scalenus anterior syndrome/thoracic outlet syndrome “

A
27
Q

Clinical features or presentation in Klumpke’s paralysis

A

Read the red highlighted :)

28
Q

Memorize this picture

A
29
Q

Memorize this picture :)

A
30
Q

Mcq: Which of the following injuries result in claw hand?
a. Damage to the superior trunk of the brachial plexus
b. Damage to the lateral cord of the brachial plexus
c. Damage to the inferior trunk of the brachial plexus
d. Damage to the posterior cord of the brachial plexus

A

c. Damage to the inferior trunk of the brachial plexus

31
Q

Mcq: What dermatome does C5 root innervate?
a. Lateral arm to the elbow
b. Thumb side of the hand and forearm
c. Back of the arm to the middle finger
d. Pinky side of the hand and forearm

A

a. Lateral arm to the elbow

32
Q

Mcq: What dermatome does C8 root innervate?
a. Lateral arm to the elbow
b. Thumb side of the hand and forearm
c. Back of the arm to the middle finger
d. Pinky side of the hand and forearm

A

d. Pinky side of the hand and forearm

33
Q

Mcq: Which nerve is formed by medial cord?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. Musculocutaneous nerve

A

c. Ulnar nerve

34
Q

Mcq: Which nerve root is affected in a “Waiter’s tip” hand position?
a. C5 & C6
b. C7
c. C8 & T1
d. C5, C6, C7, C8, & T1

A

a. C5 & C6
(Upper trunk)

35
Q

Mcq: What type of deformity is caused by ulnar nerve injury?
a. Clawed hand at the ring and little finger
b. Clawed hand at the middle and 2nd finger
c. Ape’s hand
d. Wrist drop

A

a. Clawed hand at the ring and little finger

36
Q

Mcq: Injury to which of the following will affect the function of the subclavius?
a. Inferior trunk
b. Superior trunk
c. Middle trunk
d. Posterior cord

A

b. Superior trunk
(Nerve to subclavius branch of upper trunk)

37
Q

Mcq: Injury to which of the following will affect subscapularis?
a. Superior trunk
b. Inferior trunk
c. Posterior cord
d. Lateral trunk

A

c. Posterior cord (upper & lower subscapular branches of posterior cord)

38
Q

Mcq: A man encounters an accident and there is disc prolapse. He lost sensation over the radial part of the forearm and the thumb. Where is the prolapse?
a. C5, C6, C7, C8, and T1
b. C5 & C6
c. C7 & C8
d. T1

A

b. C5 & C6

39
Q

Mcq: If the ventral roots of C8 and T1 are injured, which of the following is mostly affected?
a. Medial cord
b. Lateral cord
c. Posterior cord
d. Superior trunk

A

If lower trunk is a choice it will be the answer is it’s not there answer is:
a. Medial cord (Bcz it’s continuation of ventral division of lower trunk)

40
Q

Mcq: Formed by C7:
a. Medial cord
b. Lateral cord
c. Posterior cord
d. Superior trunk
e. Middle trunk
f. Musculocutaneous nerve
g. Median nerve
h. Axillary nerve

A

e. Middle trunk

41
Q

Mcq: Compression injury to ventral rami of C6 will lead to sensory loss of which area?
a. Axillary region
b. Medial side of the arm
c. Lateral side of the arm
d. Medial side of the forearm
e. Lateral side of the forearm

A

e. Lateral side of the forearm

42
Q

Mcq: What is the most common cause of an upper brachial plexus injury?
a. Hanging from a tree
b. Delivering a baby by pulling it from his head but shoulder becomes stuck under pubic bone
c. Getting hit by a car and falling on the shoulder
d. Direct injury to axillary region

A

b. Delivering a baby by pulling it from his head but shoulder becomes stuck under pubic bone

43
Q

Mcq: Which one of the following conveys pain sensation from the shoulder joint?
a. Median nerve
b. Radial nerve
c. Axillary nerve
d. Musculocutaneous nerve

A

c. Axillary nerve

44
Q

Mcq: Reduced sensation of medial forearm:
a. Roots injury
b. Superior trunk injury
c. Inferior trunk injury
d. Divisions injury
e. Medial cord injury

A

e. Medial cord injury

45
Q

Mcq: Reduced sensation of lateral arm:
a. Posterior cord injury
b. Superior trunk injury
c. Inferior trunk injury
d. Medial cord injury
e. Terminal branch injury

A

e. Terminal branch injury (Ulnar nerve is terminate branch of medial cord)

46
Q

Mcq: A rugby lost sensation at the radial side of the forearm and the thumb. What IV disc is most likely to be affected?
a. C3 - C4
b. C4 - C5
c. C6 - C7
d. C5 - C6

A

d. C5 - C6

47
Q

Mcq: Fracture to clavicle and injury to lower trunk, affects which nerves?
a. Ulnar and median cutaneous
b. Supraclavicular
c. Radial
d. Dorsal scapular

A

a. Ulnar and median cutaneous

Anatomy - MSK (UL) (17 decks)

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