Brachial Plexus By Dr Chaman Lal (CK)

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Brachial Plexus Anatomy and Description with illustrations, Method to draw and remember the Terminal Branches with ease.

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Brachial Plexus :

Brachial Plexus By: Dr.Chaman Lal B.S.PT, PPDPT, Dip. in sports Injuries, MPPS(PAK), PG in Clinical Electroneurophysiology (AKUH), Registered.EEGT (USA), Member of ABRET, AANEM & ASET (USA). 1 30/01/2015

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Brachial plexus: A network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb. 2 Brachial Plexus By: CK 30/01/2015

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BRACHIAL PLEXUS 5 Brachial Plexus By: CK 30/01/2015

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Vertebras & Spinal Nerves:

Vertebras & Spinal Nerves 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 7 Brachial Plexus By: CK 30/01/2015

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Flexion/Extension of the cervical spine is at; Atlanto-occipital joint Rotation of the cervical spine is at; Atlanto-axial joint 8 Brachial Plexus By: CK 30/01/2015

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Intervertebral foramen Atlas (C1) Vertebral Foramen Brachial Plexus By: CK Sacrum 14/09/2010 9 30/01/2015

Terms To Define?:

Terms To Define? Horns in Spinal Cords..? Ventral/Anterior Horn Lateral Horn Dorsal/Posterior Horn Root…? Ventral Root Dorsal Root Spinal Nerve…? Ganglion…? Ramus…? Ventral Ramus Dorsal Ramus Efferent Nerve….? Afferent Nerve…? 10 Brachial Plexus By: CK 30/01/2015

“Horns” In The Spinal Cord:

“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} 11 Brachial Plexus By: CK 30/01/2015

Terms To define….cont’d:

Terms To define….cont’d Root Ventral/Anterior/Motor/Efferent Root: It arises from Ventral or Anterior horn of the Spinal Cord and carries only motor fibers. Dorsal/Posterior/Sensory/Afferent Root: It arises from Dorsal or Posterior horn of the Spinal Cord and carries only sensory fibers. Spinal Nerve: The dorsal and ventral roots, arising from each spinal cord segment, fuse within the intervertebral foramen to form a mixed spinal nerve. 12 Brachial Plexus By: CK 30/01/2015

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Terms To define….cont’d:

Terms To define….cont’d Ganglion: Collection of the nerve cell bodies is called “Ganglion” e.g., Dorsal Root Ganglion “DRG”, sympathetic paravertebral ganglion. Ramus (Pl. rami) The spinal nerve when exits from the vertebrae it divides into two branches termed as; Ventral/Anterior Primary Ramus Dorsal/Posterior Primary Ramus Ventral/Anterior Ramus: It is the ventral or anterior division of the spinal nerve out side the vertebrae. It supplies to the skin, muscles on anterior body & viscera etc. Dorsal/Posterior Ramus: It is the dorsal or posterior division of the spinal nerve out side the vertebrae. It supplies to the skin & muscles of the back. 14 Brachial Plexus By: CK 30/01/2015

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All plexus i.e., Cervical, Brachial & Lumbo-sacral are formed by the fusion of Ventral or Anterior Primary rami of the spinal nerves. Brachial Plexus are formed by anterior primary rami of C 5 , C 6 , C 7 , C 8 , T 1 spinal nerves . Now these are termed as Ventral/ Anterior Spinal Nerve Roots. Brachial Plexus has the following relations to the surrounding structures: The roots lie between the anterior and middle scalene muscles. The trunks traverse the posterior triangle of the neck. The divisions lie behind the clavicle. The cords lie in the axilla, and are named according to their relationship with the Axillary artery. 17 Brachial Plexus By: CK 30/01/2015

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Nerve Roots C5,6,7,8,T1 Trunks Upper Middle Lower Divisions Anterior Posterior Cords Lateral Medial Posterior R OOT T RUNK D IVISIONS C ORDS B RANCHES 22 Brachial Plexus By: CK 30/01/2015

Brachial Plexus…..cont’d:

Brachial Plexus…..cont’d Roots : These are constituted by the anterior primary rami of spinal nerves C 5 , C 6 , C 7 , C 8 , T 1 . Trunks : Upper Trunk: It is formed by the combination of C 5 & C 6 spinal nerve roots. Middle Trunk: It is formed by the continuation of the C 7 spinal nerve root. Lower Trunk: It is formed by the combination of the C 8 & T 1 spinal nerve roots. The trunks traverse the posterior triangle of the neck. 23 Brachial Plexus By: CK 30/01/2015

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Brachial Plexus…..cont’d:

Brachial Plexus…..cont’d Divisions: Now each trunk give rise to two divisions i.e., 1. Anterior Division 2. Posterior Division The divisions lie behind the clavicle. Cords: Lateral Cord: It is formed by the combination of Anterior divisions of Upper & Middle Trunks . Medial Cord: It is formed by the continuation of anterior division of Lower Trunk . Posterior Cord: It is formed by the combination of all three posterior divisions of Upper , Middle & Lower Trunks. 25 Brachial Plexus By: CK 30/01/2015

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Brachial Plexus…..cont’d:

Brachial Plexus…..cont’d The cords lie in the axilla, and are named according to their relationship with the Axillary artery. Branches: Branches of the Roots: Long Thoracic Nerve (C 5 , C 6 , C 7 ) Dorsal Scapular Nerve (C 5 ) Branches of the Trunks: Suprascapular Nerve (C 5 , C 6 ) Nerve To Subclavius (C 5 , C 6 ) 27 Brachial Plexus By: CK 30/01/2015

Branches of Brachial Plexus…..cont’d:

Branches of Brachial Plexus…..cont’d Branches of the Cords: Lateral Cord (C 5 , C 6 , C 7 ) : It gives Three branches; L ateral pectoral Nerve M usculocutaneous Nerve L ateral root of Median Nerve {2LM} Medial Cord (C 8 , T 1 ): It gives Five branches; M edial Pectoral Nerve M edial Cutaneous Nerve of Arm M edial Cut.N. of forearm (Medial Antibrachial Nerve) M edial Root of Median Nerve U lnar Nerve { 4MU} 28 Brachial Plexus By: CK 30/01/2015

Branches of Brachial Plexus…..cont’d:

Branches of Brachial Plexus…..cont’d Posterior Cord (C 5 , C 6 , C 7 , C 8 , T 1 ): Upper S ubscapular Nerve Lower S ubscapular Nerve T horacodorsal Nerve (Nerve To latissimus dorsi) A xillary Nerve R adial Nerve {2STAR} Medial Antibrachial→ Medial Cord Lateral Antibrachial→ Continuation of Musculocutaneous Nerve → Lateral Cord 29 Brachial Plexus By: CK 30/01/2015

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Main Terminal Branches:

Main Terminal Branches M usculocutaneous Nerve A xillary Nerve M edian Nerve U lnar Nerve R adial Nerve 31 Brachial Plexus By: CK 30/01/2015

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October 8, 2008 Karl Merk, the world's first person to receive a complete double arm transplant . Farmer Merk who received the world's first complete double arm transplant is recovering well and able to perform some basic tasks. It still could take up to two-years until he re-learns how to use his hands. Doctors spent 15 hours on July 25-26 grafting the donor arms onto the body of 54-year-old Karl Merk, who lost his own just below the shoulder in a farm accident involving a combine six years ago. 35 Brachial Plexus By: CK 30/01/2015

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First they exposed the muscle, nerves and blood vessels to be connected. Before the bones of the donor could be cut, blood vessels in the teen’s arms were filled with a cooled preservation solution. Both arms were then removed exactly at the point matching Karl’s arm stumps.The bones were joined, then arteries and veins to ensure blood circulation as quickly as possible. The surgeons then attached the muscles and tendons, then the nerves and finally the skin. There had been no sign that Karl’s immune system was rejecting the foreign tissue and his scars were healing well. 36 Brachial Plexus By: CK 30/01/2015

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http:// www.telegraph.co.uk/news/worldnews/europe/germany/Worlds-first-double-arm-transplant-patient-delighted.html "The feeling is indescribable. Every day I gain more mobility," said Mr Merk as he showed off the arms, which are being supported by a special "corset" while the healing continues. Karl can already open a door and turn lights on and off. 37 Brachial Plexus By: CK 30/01/2015

References::

References: Snell's Text Book of Anatomy “Brachial Plexus” 23 rd Ed. Human Anatomy “Upper Limb& Thorax Anatomy” Vol.I By: B.D Chaurasia. “Anatomy & Physiology” By: Inderbir Singh, JP Brothers Publication. “ESSENCE” (A Review Book of Gross Anatomy) 6 th Ed. Dow Promotion Cell Publication. Electromyography & Neuromuscular Disorders” By David C.Preston & Barbra E.Shapiro 2 nd Ed. www.telegraph.co.uk/news/worldnews/europe/germany/Worlds-first-double-arm-transplant-patient-delighted.html 38 Brachial Plexus By: CK 30/01/2015

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“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…! 39 30/01/2015

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