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Brachial Plexus

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What are the roots of the brachial plexus?
Ventral rami of C5-T1
What are the trunks of the brachial plexus?
upper (C5-6), middle (C7), and lower (C8-T1)
What are the direct branches off the superior trunk of the brachial plexus?
suprascapular nerve (C4-5), nerve to subclavius
What nerve branch comes off the anterior division of the upper trunk of the brachial plexus?
lateral pectoral nerve
What does the anterior division of the superior trunk of the brachial plexus merge into?
the lateral cord
What does the posterior division of the superior trunk of the brachial plexus merge into?
the posterior cord
What do the divisions of the middle trunk of the brachial plexus merge into?
anterior division merges into the lateral cord, posterior division into the posterior cord
What trunk and division of the brachial plexus gives rise to the medial pectoral nerve?
anterior division of inferior trunk
What does the lateral cord become?
musculocutaneous nerve, also provides sensory axons to the median nerve
What does the posterior cord of the brachial plexus become?
axillary and radial nerves (upper subscapular, thoracodorsal, lower subscapular)
What nerve supplies the arm flexors?
musculocutaneous (C5-6)
What branches make up the median nerve?
C5-T1
What nerve supplies the flexor digitorum profundus of index and middle fingers, flexor pollicis longus and pronator quadratus?
anterior interosseous nerve
What nerve supplies forearm/wrist flexors and pronators as well as LOAF muscles in Hand (lumbricals of index and middle fingers, opponens pollicui, abductor pollicis longus and flexor pollicus brevis)?
Median nerve
What nerve supplies the deltoid and teres minor muscles?
axillary nerve (C5-6)
What nerve supplies all of the extensors of the forearm and hand?
radial nerve (C5-8)
What nerve supplies the extensors of the wrist, thumb, and fingers?
Posterior interosseus (C7-8)
What nerve supplies all intrinsic hand muscles except LOAF (lumbricals of index finger, opponenes pollicis, abductor pollicis longus, flexor pollicis brevis) muscles?
Ulnar nerve
What palsy is caused by upper plexus injury due to head/shoulder distraction?
Duchenne -Erb palsy
What palsy is caused by lower brachial plexus injury, usually traction on an abducted arm?
Klumpke's palsy
What % of patients with obstetrical brachial plexus injuries recover spontaneously?
90%
1st rib fractures may cause injuries to what portion of the brachial plexus?
lower trunk
Midhumeral fractures are often associated with injury to what nerve?
radial nerve
What vessels are often associated with plexus injury
axillary artery and vein
What syndrome is associated with a cervical rib?
thoracic outlet syndrome
What is the Gilliatt-Sumner hand?
wasting of the thenar and hypothenar muscle groups
what syndrome is associated with the Gilliatt-Sumner hand?
thoracic outlet syndrome
What nerve tumors often have well-defined margins allowing total resection?
Schwannomas
What tumors are frequently associated with Von Recklinghausen's syndrome (NF-1)?
neurofibromas
What is Parsonage-Turner syndrome?
idiopathic brachial neuritis
What are the symptoms of idiopathic brachial neuritis?
acute onset of intense shoulder pain followed by weakness in the shoulder musculature.
What is Pancoast's syndrome
brachial plexus neuropathy secondary to extrinsic compression from tumors
Where is the lesion usually found in Pancoast's syndrome?
C8-T1
How does radiation cause brachial plexus neuropathy?
fibrosis and edema of the brachial plexus
What is Horner's syndrome?
Eyelid ptosis, miosis and anhydrosis
Horner's syndrome suggests a lesion at which part of the brachial plexus?
Lower portion
What is a waiter's tip deformity?
shoulder internal rotation with elbow extension and wrist flexion
What is a claw hand?
extension at MCPs and flexion at interphalangeal joints
What is Adson's test?
Have patient hyperextend their neck and rotate their neck toward affected side while you gently tug downward on arms. A positive test is loss of radial pulse
What does a positive Adson's test indicate?
Vasculogenic thoracic outlet syndrome
What nerve is associated with a winged scapula?
long thoracic
Where do the sensory roots of the median nerve arise from?
C5-7
Where do the motor roots of the median nerve arise from?
C8-T1
Nerve root avulsion is more common in what portion of the brachial plexus?
lower plexus (nerve is bound down in connective tissue at C5-7
What is the rate of peripheral nerve regeneration?
1 mm per day (about an inch per month)
Which brachial plexus repairs have a better outcome - C5-6 or C8-T1?
C5-6
what two nerves come directly off of the roots?
long thoracic (C5,6,7); dorsal scapular nerve (C5)
what does the long thoracic nerve supply?
serratus anterior
what does the dorsal scapular nerve supply?
and levator scapulae muscles
what does the suprascapular nerve supply?
sensory fibers to the shoulder joint and provides motor innervation to the supraspinatus and infraspinatus muscles
where does the phrenic nerve lie in relation to the plexus?
anterior
where does the spinal accessory nerve (CN XI)lie in relation to the plexus?
posterior
what does the phrenic nerve supply?
diaphram
what does the accessory nerve supply?
trapezius

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