BRACHIAL PLEXUS https://dw9r2us9jo9xp.cloudfront.net/images/anatomy_term/plexus-brachialis/plexus_brachialis_atlas_ with_watermark_U5T33ghaiDg2BAFAOqTP1g.png [USEMAP] Spinal nerve [USEMAP] Plexus brachialis (C4-Th1) •within fissura scalenorum • •Senzory innervation: skin of the upper limb •Motor innervation: muscles of the upper extremity and some muscles of the back and thorax • [USEMAP] [USEMAP] Plexus brachialis (C4-Th1) •The primary bundles - trunks/trunci: •Truncus superior (C4) C5+6 •Truncus medius C7 •Truncus inferior C8+Th1 • •The secondary bundles – cords/fasciculi: •Fasciculus posterior:connection of all three posterior branches •Fasciculus lateralis: connection of anterior branches of truncus • superior and medius •Fasciculus medialis: anterior branch of truncus inferior • •The particular nerves arise from the cords: •FP: n. radialis, n. axillaris •FL: n. musculocutaneus + part of n. medianus •FM: n. ulnaris + part of n. medianus • [USEMAP] bp_diagram_final [USEMAP] Schématický nákres plexus brachialis Result: there are axons from more segments within one nerve– by injury of the root, there can be paralysis of more muscles [USEMAP] plexus [USEMAP] •scalenus syndrome (fissura scalenorum) •Costoclavicular syndrome (1th rib and clavicle) •Brachial Plexus Avulsion Injuries (the nerves are actually teraed out of the spinal cord) http://www.doereport.com/imagescooked/76282W.jpg [USEMAP] Pars supraclavicularis plexus brachialis •Innervation: some back muscles (spinohumeral) + some thoracic muscles + muscles of scapula • [USEMAP] nervus dorsalis scapulae (C5-6) •m. levator scapulae et mm. rhomboidei bp_diagram_final [USEMAP] backvessels [USEMAP] nervus thoracicus longus (C5-7) •m. serratus anterior bp_diagram_final [USEMAP] nervus thoracicus longus (C5-7) [USEMAP] long thoracic nerve [USEMAP] nervus thoracicus longus (C5-7) •scapula alata http://www.itfnoroloji.org/spinalsinir/spin22b.jpg [USEMAP] nervus subclavius C4-6 •m. subclavius plexus [USEMAP] [USEMAP] nervus suprascapularis (C4-6) •m. supraspinatus, m. infraspinatus, sensory innervation of articular capsule of the shoulder joint bp_diagram_final [USEMAP] image810 [USEMAP] suprascapular nerve [USEMAP] nervi subscapulares C5-7 •m. subscapularis, m. teres major bp_diagram_final [USEMAP] subscapular nerve [USEMAP] Nervus subscapularis [USEMAP] nervus pectoralis lateralis C5-7 •m. pectoralis major et minor bp_diagram_final [USEMAP] Lateral pectoral nerve [USEMAP] Nervus pectoralis lateralis [USEMAP] nervus pectoralis medialis C8-Th1 •m. pectoralis major et minor bp_diagram_final [USEMAP] Medial pectoral nerve [USEMAP] Nervus pectoralis medialis [USEMAP] nervus thoracodorsalis C6-8 •m. latissimus dorsi bp_diagram_final [USEMAP] thoracodorsal nerve [USEMAP] Pars infraclavicularis plexus brachialis •Innervation: motor innervation of muscles of the upper limb, sensory innervation of skin of the upper limb • [USEMAP] Pars infraclavicularis plexus brachialis •fasciculus lateralis •fasciculus medialis •fasciculus posterior [USEMAP] [USEMAP] Fasciculus lateralis n. musculocutaneus (mixed) (C5–7) rr. musculares (m. coracobrachialis, m. biceps brachii, m. brachialis) n. cutaneus antebrachii lateralis vulnerable place - fossa cubiti radix lateralis n. mediani [USEMAP] Nerves_of_the_left_upper_extremity image814 image812 [USEMAP] [USEMAP] musculocutaneous nerve [USEMAP] lateral cutaneous nerve of the forearm [USEMAP] [USEMAP] •Fasciculus medialis •radix medialis n. mediani •n. cutaneus brachii medialis (C8–Th1) •Connections with nn. intercostales II., (III.) – nn. intercostobrachiales •n. cutaneus antebrachii medialis (C8–Th1) • (it passes through hiatus basilicus into the subcutaneous tissue and it continues distally onto the antebrachium) • r. anterior et r. ulnaris •n. ulnaris [USEMAP] [USEMAP] image811 image812 image813 image814 [USEMAP] medial cutaneous nerve of the forearm [USEMAP] File:Gray812and814.PNG •n. ulnaris - (mixed) (C8–Th1) •- It runs on the medial side of the arm, then within sulcus nervi ulnaris, between m. flexor carpi ulnaris and m. flexor digitorum profundus together with a. ulnaris and further toward the palm on the surface of retinaculum flexorum •rr. articulares •rr. musculares •r. dorsalis n. ulnari • - nn. digitales dorsales •r. palmaris n. ulnaris •N. ulnaris divides within the palm into: •r. superficialis • - r. muscularis (m. palmaris brevis) • - 2 nn. digitales palmares communes et proprii •r. profundus - rr. musculares • •Motor innervation: m. flexor carpi ulnaris, m. flexor digitorum profundus (for 4th and 5th finger), muscles of hypothenar, m. adductor pollicis and m. flexor pollicis brevis (caput profundum), mm. interossei, mm. lumbricales (III. and IV.) •Sensory innervation: on the palm: 5th and half of 4th finger • on dorsum: 5th, 4th and half of 3rd finger [USEMAP] [USEMAP] File:Gray812and814.PNG [USEMAP] ulnar nerve [USEMAP] Nervus ulnaris [USEMAP] Elbow Cubital Tunnel Anatomy, Bones b_15_3_2a Canalis cubitalis -Cubital tunelle syndrome (lesion of n. ulnaris within sulcus nervi ulnaris) Guyon´s canal (between os pisiforme and hamulus ossis hamati) hand_guyon_canal_causes02 [USEMAP] Guyonův kanálek Claw hand Soubor:Obrna n.ulnaris.png [USEMAP] Drápovitá ruka •n. medianus •mixed(C5–Th1) – radix med. (C8–Th1), radix lat. (C6-8) • it passes along a. brachialis, between m. pronator teres and flexor digitorum superficialis and then between the deep and superficial flexor (into the palm below retinaculum flexorum) •rr. musculares, rr. articulares •n. interosseus antebrachii anterior •r. palmaris •Within the palm: •r. communicans cum nervo ulnari (at the level of canalis carpi) •r. thenaris (rr. musculares) •nn. digitales palmares comm.- nn. digitales palmares proprii •Motor innervation: muscles of the anterior group of forearm (except m. flexor carpi ulnaris and part of m. flexor digitorum profundus), m. abductor pollicis brevis , m. opponens pollicis, m. flexor pollicis brevis (caput superficiale) •Sensory innervation: thenar part of the palm and palmar part of fingers till the borderline which lies in the middle of 4th finger norma [USEMAP] [USEMAP] File:Gray812and814.PNG [USEMAP] The Median Nerve [USEMAP] median nerve [USEMAP] Nervus medianus [USEMAP] syndrom_karpalniho_tulenelu_pricny_rez b_15_3_2b Hand of benediction (inability of oposition of thumb and flexion of 2nd and 3rd finger) Ape hand - Oposition of thumb stagnates The injury of the nerve: • suicide attempts (gashes) • patological changes within carpal tunnel • gripping movement is missing [USEMAP] Syndrom opičí ruky- vázne opozice palce [USEMAP] •Fasciculus posterior •n. axillaris • foramen humerotricipitale •(mixed) (C5–6) •rr. musculares •rr. articulares •n. cutaneus brachii lat. sup. • •Motor innervation: m. deltoideus, m. teres minor •Sensory innervation: the area around the shoulder • The injury of the nerve (luxation, fracture of collum chirurgicum) • supionation and abduction of the arm till horizontal are missing [USEMAP] axillary nerve [USEMAP] •n. radialis •(mixed) (C5–Th1) •n. cutaneus brachii posterior •n. cutaneus brachii lateralis inferior •rr. musculares • •n. cutaneus antebrachii posterior •Branching within cubital area(between m. brachialis and m. brachioradialis) •r. profundus (muscles of the dorsal group of forearm) • n. interosseus antebrachii posterior (sensory nerve) •r. superficialis (below m. brachioradialis onto dorsum manus) • nn. digitales dorsales • •Motor innervation: m. triceps brachii, lateral group of forearm muscles, m. supinator, muscles of the posterior side of forearm •Sensory innervation: dorsal surface of wrist and 1st, 2nd and half of 3rd finger • [USEMAP] [USEMAP] File:Gray812and814.PNG n. radialis 1 [USEMAP] radial nerve [USEMAP] Nervus radialis [USEMAP] posterior cutaneous nerve of the forearm [USEMAP] sken1 Canalis supinatorius Drop wrist The injury of the nerve: on the arm (fractures) • palsy of extensors of hand – it drops in palmar direction [USEMAP] Canalis supinatorius Syndrom labutího krku [USEMAP] [USEMAP] [USEMAP] •Obrázky: •Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München:Urban & Schwarzenberg, 1993 •Netter: Interactive Atlas of Human Anatomy. •Naňka, Elišková: Přehled anatomie. Galén, Praha 2009. •Čihák: Anatomie I, II, III. •Drake et al: Gray´s Anatomy for Students. 2010 [USEMAP] 1 infraspinatus muscle [USEMAP] 2 flexor digitorum superficialis muscle 3 Lumbrical muscles of the Hand 4 palmaris longus muscle 5 biceps brachii muscle 6 pronator quadratus muscle 7 extensor digitorum muscle 8 supinator muscle 9 subscapularis muscle 10 teres major muscle 11 pronator teres muscle 12 brachialis muscle 13 anconeus muscle 14 coracobrachialis muscle 15 Palmaris brevis muscle 16 Deltoid muscle 17 extensor indicis muscle 18 Musculus triceps brachii 19 adductor pollicis muscle 20 brachioradialis muscle •1) m. infraspinatus •2) m. flexor digitorum superficialis •3) mm. lumbricales •4) m. palmaris longus •5) m. biceps brachii •6) m. pronator quadratus •7) m. extensor digitorum communis •8) m. supinator •9) m. subscapularis •10) m. teres major •11) m. pronator teres •12) m. brachialis •13) m. anconaeus •14) m. coracobrachialis •15) m. palmaris brevis •16) m. deltoideus •17) m. extensor indicis •18) m. triceps brachii •19) m. adductor pollicis •20) m. brachioradialis Thank you for your attention!