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Transcript of 4 5cervicalbrachialplexus-120130181444-phpapp01
ANATOMY MUSKULOSKELETAL Cervical Plexus and Brachial Plexus
By : Hermizan Halihanafiah
COLLEGE OF ALLIED HEALTH AND SCIENCES
The Spinal Nerves31 pairs of spinal nerves (1st cervical above C1)
mixed nerves exiting at intervertebral foramenProximal branches
Dorsal (posterior) root is sensory input to spinal cordVentral (anterior) root is motor output of spinal cord
Distal branchesdorsal ramus supplies dorsal body muscle and skinventral ramus to ventral skin and muscles and limbsmeningeal branch to meninges, vertebrae and ligaments
Branches of a Spinal Nerve
Spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal.
Each has dorsal and ventral ramus.
Notice the branching and merging of nerves in this example of a plexus
Nerve Plexuses
Ventral rami branch and anastomose
repeatedly to form 5 nerve plexuses
cervical plexus
brachial plexus
Lumbar plexus
Sacral plexus
Coccygeal plexus
Spinal Nerve Roots and Plexuses
Nerves PlexusesThe ventral (anterior) rami of spinal nerves, except
for thoracic nerves T2-T12, do not go directly to the body structures they supply.
They form networks on the both the left and right sides of the body by joining with various numbers of axons from anterior rami of adjacent nerves.
Ventral rami branch and anastomose repeatedly to form 5 nerve plexuses
Nerves Plexus The principal plexuses are:
1. Cervical plexus
2. Brachial plexus
3. Lumbar plexus
4. Sacral plexus
5. Cocygeal plexus
Cervical PlexusFormed by the anterior (ventral) rami of the
cervical nerves C1-C4 with contribution C5.Supplies the skin and muscles of the head,
neck and superior part of the shoulders and chest.
Phrenic nerves arise from the cervical, innervate for the diaphragm muscles.
The Cervical Plexus
Terminal Branches Superficial branches (Sensory)1. Lesser occipital (C2) – skin of scalp
posterior and superior to ear.2. Great auricular (C2-C3) – skin anterior,
inferior, and over ear and over parotid gland.
3. Transverse cervical (C2-C3) – skin over anterior aspect of neck.
4. Supraclavicular (C3-C4) – skin over superior portion of chest and shoulder.
Transverse Cervical nerve
C2,C3
Supraclavicular nerve C2, C3
Greater Auricular nerve C2,C3
Lesser occipital nerve C2 (ventral
rami)
Greater occipital nerve
C2 (dorsal rami)
Deep Branches (Motor)1. Ansa cervicalis (superior root) – infrahyoid
and geniohyoid muscles of the neck.2. Ansa cervicalis (inferior root) – infrahyoid
muscles of neck.3. Phrenic nerve – diaphragm4. Segmental branches – prevertebral muscles
of the neck, levator scapulae and middle fiber of scalene.
Terminal Branches
Brachial PlexusThe anterior (ventral) rami of spinal nerves C5-C8
and T1 form the brachial plexus.
Extends inferiorly and laterally on either side of the last four cervical and first thoracic vertebrae through intervetebral foramen.
Passes above the first rib posterior to the clavicle and then enter the axilla (cervicoaxillary canal).
The brachial plexus provide the entire nerve supply
of the shoulder and upper limbs.
Five important nerves arise from brachial
plexus are:
1. Axillary nerve
2. Musculocutaneous nerve
3. Radial nerve
4. Median nerve
5. Ulnar nerve
Brachial Plexus
Nerve SupplyThe nerve that supplying
the structures in the arm
are all derivative from the
brachial plexus.
Brachial plexus is a
complex of intermingling
nerves that originate from
the neck (cervical and
thoracic origin)
Brachial plexus is formed by the ventral
(anterior) rami of the lower cervical nerves
and the first thoracic nerves. (C5, C6, C7, C8, T1)
Occasionally, there maybe a contribution from C4
or T2 or both.
Nerve Supply
Brachial PlexusThe anterior (ventral) rami of spinal nerves C5-
C8 and T1 form the brachial plexus.
Extends inferiorly and laterally on either side of
the last four cervical and first thoracic vertebrae.
Passes above the first rib posterior to the clavicle
and then enter the axilla (passes through
cervicoaxillary canal).
The brachial plexus provide the entire nerve supply
of the shoulder and upper limbs.
Five important nerves arise from brachial plexus are:
1. Axillary nerve
2. Musculocutaneous nerve
3. Radial nerve
4. Median nerve
5. Ulnar nerve
Brachial Plexus
Levels of Brachial PlexusRoots
Trunks
Divisions
Cords
Branches
Real
Trainers
Drink
Cold
Beer
RootsThe five roots are the five anterior(ventral) rami of
the spinal nerves, after they have given off their
segmental supply to the muscles of the neck.
These roots merge to form three trunks:
"superior" or "upper" (C5-C6)
"middle"(C7)
"inferior" or "lower" (C8-T1)
TrunkEach trunk then splits in two, to form six
divisions:
anterior division of the upper, middle
and lower trunks
posterior division of the upper, middle,
and lower trunks
Division and Cords
These six divisions will regroup to become the
three cords. The cords are named by their position
in respect to the axillary artery.
The posterior cord is formed from the three
posterior divisions of the trunks (C5-T1)
The lateral cord is the anterior divisions from the
upper and middle trunks (C5-C7)
The medial cord is simply a continuation of the
anterior division of the lower trunk (C8-T1)
Spesific BranchesOne can remember the specific branches of
lateral, posterior and medial cord using the mnemonic LML, ULNAR , M4U respectively.
LML - lateral pectoral nerve , musculocutaneous nerve , lateral root of the median nerve.
ULNAR - upper subscapular nerve , lower subscapular nerve , nerve to latissmus dorsi (thoracodorsal nerve) , axillary nerve , radial nerve.
M4U - medial pectoral nerve , medial root of the median nerve , medial cutaneous nerve of the arm , medial cutaneous nerve of the forearm , ulnar nerve.
Learn the Brachial Plexusin Five Minutes or Less!!
Draw two headless arrows to the right.
Add a headless arrow to the left
Add a “W “
Add an “X”
Add a “Y”. (Just a branch of the “Y”is added.)
Label C5 to T1.
Label the major branches:
More complex diagramming of the brachial plexus includes the four “3s.”
The first “3”is the branches to C5, 6, and 7 which form LTN = long thoracic nerve.
Next, each of the headless arrows has three nerves attached to it.To the top headless arrow, add its “3.”
Label these “3”:DSN = dorsoscapular nerve; SS = suprascapular nerve;LP = lateral pectoral nerve
Add the “3”to the middle headless arrow.
Label the second headless arrow “3”: SS = subscapular, TD = thoracodorsal nerve.
Add the final “3”on the bottom headless arrow
*Label the last “3.”MP = medial pectoral,MBC = medial brachial
cutaneous, and MABC = medial antebrachial cutaneous.
*Remember: the brachial cutaneous goes to the brachium or
arm, and the MABC goes to the antebrachium or forearm.
Label roots, trunks, divisions, cords, terminal branches.
Radiologists, neurosurgeons and thoracic surgeons need to know the nerve to the subclavius(SUB).
The complete brachial plexus diagram
From Nerve Root Muscles
Roots Dorsal scapular C5 Rhomboid minor, major and levator
scapulae
Roots Long thoracic C5, C6, C7
Serratus anterior
Superior trunk
Subclavian C5, C6 Subclavius
Superior trunk
Suprascapular C6, C6 Supraspinatus, infraspinatus
From Nerve Root Muscles
Lateral cord Lateral pectoral nerve
C5. C6, C7
Pectoralis major
Lateral cord Musculocutaneous nerve
C5. C6, C7
Coracobrachialis, brachialis, biceps
brachii
Lateral cord Lateral root of the median nerve
C5. C6, C7
Fibers to the median nerve
Posterior cord
Upper subcsapular nerve
C5, C6 Subscapularis
From Nerve Root Muscles
Posterior cord
Thoracodorsal nerve
C6, C7, C8 Latissimus dorsi
Posterior cord
Lower subscapular
C5, C6 Subscapularis
Posterior cord
Axillary nerve
C5, C6 Anterior branch: Deltoid
Posterior branch: Teres minor
Posterior cord
Radial nerve C5-C8, T1 Triceps brachii, supinator,
anconeus, extensor muscles move the
hand, brachioradialis
From Nerve Root Muscles
Medial cord Medial pectoral nerve
C8, T1 Pectoralis major, Pectoralis minor
Medial cord Medial root of median nerve
C8, T1 Fibers to the median nerve
Medial cord Medial cutaneous nerve of the arm (medial brachial cutaneous)
C8, T1 Skin of medial and posterior aspect of distal third of arm
Medial cord Medial cutaneous nerve of the forearm (medial antebrachial cutaneous)
C8, T1 Skin of medial and posterior aspects of forearm
From Nerve Root Muscles
Medial cord Ulnar nerve C8, T1 Flexor carpi ulnaris, flexor digitorum profundus, most of the small muscles of the hand
Summary1. Branches from the roots Nerves to the scalene and longus colli (C5, 6, 7,
8) A branch to the phrenic nerve (C5) Dorsal scapular nerve (C5) Long thorasic nerve (C5, 6, 7)
2. Branches from the trunks Nerve to subclavius / subclavian nerve (C(4), 5,
6) Suprascapular nerve (C(4), 5, 6)
3. There are no nerves arising from the divisions
4. Branches from the cords of the plexusi. Medial cord Medial pectoral nerve (C8, T1) Medial brachial cutaneous nerve (T1) Medial antebrachial cutaneous nerve (C8,
T1) Ulnar nerve (C(7), 8, T1) Medial part of the median nerve (C8, T1)
Summary
4. Branches from the cords of the plexusii. Posterior cord Upper subscapular nerve (C(4), 5, 6, (7)) Thoracodorsal nerve (C(5), 7. 8) Lower subscapular nerve (C5, 6) Axillary nerve (C5, 6) Radial nerve (C5, 6)
Summary
4. Branches from the cords of the plexusiii. Lateral cord Lateral pectoral nerve (C5, 6, 7) Musculocutaneous nerve (C5, 6, 7) Lateral part of the median nerve (C(5), 6, 7))
Summary