Upper Extremity Blocks

Question 1

Name the sections of the Brachial plexus and number of each section.

Answer 1

Roots 5
Trunks 3
Divisions 6
Cords 3
Branches 5

“Randy travis drinks cold beers”

Question 2

Name the 3 trunks of the brachial plexus

Answer 2

Superior
Middle
Inferior

Question 3

Name the three cords of the brachial plexus. What structure are they named in relation to?

Answer 3

Lateral
Postier
Medial

Named in relation to axillary artery

Question 4

Where do the 5 roots of the Brachial plexus originate?

Answer 4

from ventral primary rami of C5-T1 spinal nerves

Question 5

Anatomically where are the brachial plexus roots?

Answer 5

Between the anterior and middle scalene muscles.

Question 6

Does C4 ever contribute to the brachial plexus?

Answer 6

Yes, it can in some patients and when it does is called a prefixed plexus

Question 7

Does T2 ever contribute to the brachial plexus?

Answer 7

Yes, it can in some patients. When it does it is called a postfixed plexus

Question 8

Anatomically where are the trunks of the brachial plexus?

Answer 8

Just beyond the lateral border of the scalene muscles.

Question 9

Anatomically where are the divisions of the brachial plexus?

Answer 9

Under the clavicle and over the 1st rib

Question 10

Each trunks of the brachial plexus divides into what?

Answer 10

Anterior and Posterior divisions

Question 11

What do the anterior divisions of the brachial plexus innervate?

Answer 11

Anterior aspect of the arm or the “flexors”

Question 12

What do the posterior divisions of the brachial plexus innervate?

Answer 12

Posterior aspect of the arm or the “extensors”

Question 13

Anatomically where are the cords of the brachial plexus? In relations to what structure are they named?

Answer 13

Under Pec minor

Named in relation to the axillary artery

Question 14

Anatomically where are the branches of the brachial plexus?

Answer 14

In the axilla

Question 15

Which ventral rami contribute to the Musculocutaneous nerve?

Answer 15

C5-C7

Question 16

Which ventral rami contribute to the Axillary nerve?

Answer 16

C5-C6

Question 17

Which ventral rami contribute to the Radial nerve?

Answer 17

C5-T1

Question 18

Which ventral rami contribute to the Median nerve?

Answer 18

C5-T1

Question 19

Which ventral rami contribute to the Ulnar nerve?

Answer 19

C8-T1

Question 20

How can we divide the non terminal branches of brachial plexus with the greatest significance to regional anesthesia?

Answer 20

Either supra or infra clavicular.

Question 21

What are the supraclavicular non terminal branches of the BP that are most significant for regional anesthesia?

Answer 21

Dorsal Scapular N.
Supra scapular N.
Long thoracic N.

Question 22

Dorsal scapular nerve comes from which ventral rami?

Answer 22

C5

Question 23

Suprascapular nerve comes from which ventral rami?

Answer 23

C5-C6

Question 24

Long thoracic n. comes from which ventral rami?

Answer 24

C5-C7

Question 25

Which infraclavicular non terminal branches of BP are most significant for regional anesthesia?

Answer 25

Lateral pectoral n. Medial pectoral n.

Question 26

lateral pectoral n. comes from which ventral rami?

Answer 26

C5-C7

Question 27

medial pectoral n. comes from which ventral rami?

Answer 27

C8-T1

Question 28

Is phrenic nerve part of Brachial plexus?

Answer 28

No, but does receive contributions from C5

Question 29

Where does supraclavicular nerve come from?

Answer 29

cervical plexus

Question 30

Where does intercostobrachial nerve come from?

Answer 30

2nd intercostal nerve

Question 31

How to perform intercostobrachial nerve field block?

Answer 31

start at dletoid prominence and move inferiorly twoards the triceps injecting 5ml of LA

Question 32

What is the mnemonic for clinical assessment of Brachial plexus block?

Answer 32

Push'eR: Elbow extension against resistance (triceps contraction) > Radial n. Pull'eM: Elbow flexion against resistance (biceps contraction) musculocutaneous n. Pinch Me: Pinch index finger (2nd digit) > median nerve Pinch U: pinch pinky finger 5th digit > Ulnar N.

Question 33

Which peripheral nerves from BP are sensory only?

Answer 33

Medial brachial cutaneous and medial ante brachial cutaneous

Question 34

Name the anatomic landmarks for median n block at the wrist

Answer 34

flexor carpi radialis tendon and flexor palmaris longus tendon

Question 35

Name the anatomic landmarks for radial n block at the wrist

Answer 35

radial styloid

Question 36

Name the anatomic landmarks for ulnar n block at the wrist

Answer 36

ulnar styloid ulnar pulse flexor carpi ulnaris tendon