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Nerve Supply Of The Upper Limb Flashcards

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1
Q

Major nerve network that supplies the upper limb

Begins in the neck and extends into the axilla

A

Brachial Plexus

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2
Q

Brachial Plexus is formed by the union of the:

A 
Anterior rami of the last four cervical (C5-C8)
first thoracic (T1) nerve roots
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3
Q

Where is the brachial plexus located (during dissection)?

A

Posterior Triangle of the Neck

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4
Q

Posterior Triangle of the Neck

Surface Landmarks

A

Anterior: Sternocleidomastoid
Posterior: Trapezius
Inferior: Middle third of the clavicle

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5
Q

Brachial plexus together with the subclavian artery emerges between the anterior and middle __.

A

Scalene muscles

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6
Q

Five Major Segments of the Brachial Plexus

Ro-Tun-Da Cu-Bao
Reach To Drink Cold Beer

A 
Roots
Trunks
Divisions
Cords
Branches
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7
Q

Root anatomy

Dorsal root:

A

Sensation

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8
Q

Root anatomy

Ventral root:

A

Motor

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9
Q

The C5-C7 nerve roots are located __.

A

Above their corresponding vertebral body

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10
Q

Root

C8 is located __.

A

Below the C7 vertebral body

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11
Q

Root

T1 is located below the __.

A

T1 vertebral body

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12
Q

Root

C5 Motor

A 
Shoulder Abduction
Elbow Flexion (palm up)
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13
Q

Root

C5 Sensory

A

Lateral aspect of the arm

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14
Q

Root

C5 Reflex

A

Biceps

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15
Q

Root

C6 Motor

A 
Elbow flexion (thumb up)
Wrist extension
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16
Q

Root

C6 Sensory

A

Lateral forearm and thumb

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17
Q

Root

C6 Reflex

A

Brachioradialis

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18
Q

Root

C7 Motor

A

Elbow extension

Wrist flexion

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19
Q

Root

C7 Sensory

A

Middle and ring finger

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20
Q

Root

C7 Reflex

A

Triceps

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21
Q

Root

C8 Motor

A

Finger flexion, thumb extension

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22
Q

Root

C8 Sensory

A

Medial aspect of forearm and inferior arm

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23
Q

Root

T1 Motor

A

Finger abduction (Interossei)

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24
Q

Root

T1 Sensory

A

Medial aspect of the superior arm and skin of the axilla

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25
Branches that arise at the root level
1. Long Thoracic Nerve (C5-C6-C7) | 2. Dorsal Scapular Nerve (C5)
26
Long Thoracic Nerve (C5-C6-C7) | Innervates the:
Serratus anterior
27
Long Thoracic Nerve (C5-C6-C7) | Abducts the:
Scapula
28
Long Thoracic Nerve (C5-C6-C7) | Injury:
Scapular Winging
29
Dorsal Scapular Nerve (C5) | Innervates the:
Major and minor rhomboids
30
Dorsal Scapular Nerve (C5) | Action:
Draws scapula to the spine
31
Formed by roots after they emerge from the scalenes
Trunks [3]
32
Trunk | C5+C6:
Superior Trunk
33
Trunk | C7:
Middle Trunk
34
Trunk | C8+T1:
Inferior Trunk
35
Nerves that arise at the Trunk level:
1. Suprascapular Nerve | 2. Subclavian Nerve
36
Suprascapular Nerve Superior trunk (C5-C6) Innervates:
* Supraspinatus (shoulder abduction) | * Infraspinatus (shoulder external rotation)
37
Subclavian Nerve •Superior trunk (C5-C6) Innervates:
The subclavius muscle and sternoclavicular joint
38
Each trunk (superior, middle and inferior) gives rise to two divisions:
Anterior and posterior division
39
Divisions Occur at the level of the:
Clavicle
40
Anterior divisions supply the __ of the upper limb
Anterior (flexor) compartments
41
Posterior divisions supply the:
Posterior (extensor) compartments
42
Three cords labelled according to their position relative to the axillary artery:
1. Lateral cord 2. Medial cord 3. Posterior cord
43
Formed by the 💡anterior divisions of the 💡superior and 💡middle trunks
Lateral Cord
44
Continuation of the 💡anterior division of the 💡inferior trunk
Medial Cord
45
Formed by the union of the 💡posterior divisions of all three trunks
Posterior Cord
46
Nerves that arise at the Cord level:
``` Lateral Pectoral Nerve Medial Pectoral Nerve Thoracodorsal Nerve Upper Subscapular Nerve Lower Subscapular Nerve ```
47
Lateral Pectoral Nerve from:
Lateral Cord (C5)
48
Lateral Pectoral Nerve Innervates:
Clavicular head of pectoralis major
49
Lateral Pectoral Nerve Action:
Adducts and Internally Rotates shoulder
50
Medial Pectoral Nerve from:
Medial Cord (C8)
51
Medial Pectoral Nerve Innervates:
Sternal head of pectoralis major and pectoralis minor
52
Medial Pectoral Nerve Action:
Adducts shoulder
53
Thoracodorsal Nerve from:
Posterior Cord (C5)
54
Thoracodorsal Nerve Innervates:
Latissimus dorsi
55
Thoracodorsal Nerve Action:
Adducts and internally rotates the shoulder
56
Upper Subscapular Nerve from:
Posterior Cord (C5)
57
Upper Subscapular Nerve Innervates:
Subscapularis
58
Upper Subscapular Nerve Action:
Internally rotates shoulder
59
Lower Subscapular Nerve from:
Posterior Cord (C6)
60
Lower Subscapular Nerve Innervates:
Subscapularis, and teres major
61
Lower Subscapular Nerve Action:
Internally rotates shoulder
62
Terminal Branches /Peripheral Nerves [5]
Axillary Nerve (from posterior cord) Musculocutaneous Nerve (from lateral cord) Radial Nerve (from posterior cord) Median Nerve (from lateral and medial cord) Ulnar Nerve (from medial cord)
63
Axillary Nerve From:
Posterior cord (C5-C6)
64
Axillary Nerve Exits the:
Axillary fossa posteriorly
65
Axillary Nerve Passing through the
Quadrangular space with the posterior circumflex humeral artery
66
Axillary Nerve Gives rise to
Superior lateral brachial cutaneous nerve
67
Axillary Nerve Winds around
Surgical neck of the humerus deep to the deltoid
68
Axillary Nerve Structures Innervated:
Teres Minor and Deltoid (Flexion, abduction, external rotation of the Shoulder) Glenohumeral (Shoulder) Joint
69
Axillary Nerve Sensory Innervation:
Skin of superolateral arm (over inferior part of deltoid)
70
Spaces of the Posterior Shoulder | Spaces in between muscles through which arteries and nerves pass through
1. Quadrangular Space 2. Triangular Interval 3. Triangular Space
71
Quadrangular space Borders:
Superior: Teres minor Lateral: Lateral head of triceps Medial: Long head of triceps Inferior: Teres major
72
Quadrangular space Contents:
Posterior circumflex artery | Axillary nerve
73
Triangular Interval Borders:
Superior: Teres major Lateral: Lateral head of triceps Medial: Long head of triceps
74
Triangular Interval Contents:
Profunda brachii | Radial nerve
75
Triangular space Borders:
Superior: Teres minor Inferior: Teres major Lateral: Long head of triceps
76
Triangular space Contents:
Circumflex scapular artery
77
Terminal branch of the lateral cord | C5-C7
Musculocutaneous Nerve
78
Musculocutaneous Nerve | Exits axilla by piercing the:
Coracobrachialis
79
Musculocutaneous Nerve | Descends between:
Biceps brachii and brachialis
80
Musculocutaneous Nerve Continuous as the:
Lateral antebrachial cutaneous nerve of the forearm
81
Musculocutaneous Nerve Structures innervated:
Coracobrachialis, biceps brachii, brachialis (Elbow flexion)
82
Musculocutaneous Nerve Sensory innervation:
Skin at lateral aspect of the forearm
83
Arises from the 💡Posterior cord (C5-T1) and the 💡largest branch of the brachial plexus
Radial Nerve
84
Radial Nerve Exits:
Axillary fossa posterior to axillary artery
85
Radial Nerve | Passes posterior to:
Humerus in radial groove with deep brachial artery in the triangular interval between the lateral and medial heads of the triceps
86
Radial Nerve Perforates:
Lateral intermuscular septum as it exits the posterior compartment of the arm
87
Radial Nerve Enters:
Cubital fossa, dividing into superficial (cutaneous) and deep (motor) radial nerves
88
Radial Nerve | Branches in the forearm and wrist:
1. Posterior interosseous nerve 2. Superficial branch of the radial nerve 3. Posterior cutaneous nerve of the forearm
89
Radial Nerve | Structures innervated:
All muscles of the posterior compartments of the arm (e.g. triceps) and forearm (e.g. brachialis, extensor carpi radialis longus)
90
Radial Nerve: | Sensory Innervation
* Skin of the posterior and inferolateral arm * Posterior forearm * Dorsum of the hand lateral to the axial line of the ring finger
91
Arises from the 💡lateral cord (C6, C7) and 💡medial cord (C8, T1)
Median Nerve
92
Median Nerve exits the cubital fossa by passing between the heads of the
Pronator teres
93
Median Nerve runs deep to palmaris longus tendon as it approaches the flexor retinaculum to traverse the
Carpal tunnel
94
Median Nerve | Branches:
1. Anterior interosseous nerve | 2. Palmar cutaneous branch of the median nerve
95
Median Nerve | Structures innervated
•Muscles of the anterior forearm compartment (except for the flexor carpi ulnaris and the ulnar half of flexor digitorum profundus) ``` •Five intrinsic muscles in the thenar half of the palm (OAF+2) 1. 1st and 2nd lumbricals 2. Opponens pollicis 3. Abductor pollicis brevis 4. Flexor pollicis brevis ```
96
Median Nerve Provides sensation to the:
Thenar half (radial 3 ½ digits) of the palmar skin
97
Ulnar nerve Arises from the:
Medial cord (C7 –T1)
98
Ulnar nerve | Passes posterior to the
Medial epicondyle of the humerus
99
Ulnar nerve | Branches:
1. Palmar cutaneous branch of the ulnar nerve | 2. Dorsal cutaneous branch of the ulnar nerve
100
Ulnar nerve | Structures innervated:
* Flexor carpi ulnaris and ulnar half of the flexor digitorum profundus (forearm) * Most of the intrinsic muscles of the hand (hypothenar muscles, lumbricals and interossei)
101
Ulnar nerve | Provides sensation:
•Skin of the ulnar side of the hand along the ring and small finger
102
Occur during difficult deliveries in infants
Obstetric Brachial Plexus Palsy
103
Obstetric Brachial Plexus Palsy Two Types:
1. Erb-Duchenne Palsy | 2. Klumpke’s Palsy
104
 Most common type, upper lesion  Mechanism of injury: lateral flexion of the head towards the contralateral shoulder with depression of the ipsilateral shoulder causing traction in infants  PE: Adducted, internally rotated shoulder; pronated forearm, extended elbow (💡Waiter’s Tip)  Prognosis and Treatment: Observation, best prognosis for spontaneous recovery
Erb-Duchenne Palsy | C5,C6
105
 Rare type  Mechanism of injury: Arm presentation with subsequent traction/abduction from trunk  PE: deficit of all of the small muscles of the hand (ulnar and median nerves)  💡“Claw Hand” deformity • Wrist in 💡extreme extension because of the unopposed wrist extensors • 💡Hyperextension of the MCP and 💡flexion of the IP joints due to 💡loss of hand intrinsics  Prognosis: Poor for spontaneous recovery
Klumpke’s Palsy | C8, T1
106
 Muscles in the posterior compartment of the forearm are paralyzed  💡“Wrist Drop” – inability to extend the wrist and fingers at the metacarpophalangeal joints
Radial Nerve Palsy | Humerus Fracture
107
Results from any lesion that significantly reduces the size of the carpal tunnel, increases the size of the structures or their coverings that pass through it Causes: inflammation of synovial sheaths, fluid retention, infection, tumors
Carpal tunnel syndrome
108
Most sensitive structure in carpal tunnel
Median nerve
109
Carpal tunnel syndrome |  Signs and symptoms:
1. Paresthesia (tingling), hypoesthesia (diminished sensation), or anesthesia (absence of sensation) may occur in the lateral three and a half digits. 2. Inability to oppose the thumb 3. Atrophy of the thenar eminence (thenar muscles)
110
Carpal tunnel syndrome | Treatment:
Rest and splint immobilization, | steroid injection or carpal tunnel release

GROSS ANATOMY (8 decks)

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