DOCSLIB.ORG

Brachial Plexus and Lumbosacral Plexus

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Brachial Plexus and Lumbosacral Plexus Brachial Plexus and Lumbosacral Plexus Neuroanatomy block-Anatomy-Lecture 4 Editing file Objectives At the end of the lecture, students should be able to: ● Describe the formation of brachial plexus (site, roots) ● List the main branches of brachial plexus. ● Describe the formation of lumbosacral plexus (site,roots) ● List the main branches of lumbosacral plexus. ● Describe some important applied Anatomy related to the brachial & lumbosacral plexuses. Color guide ● Only in boys slides in Green ● Only in girls slides in Purple ● important in Red ● Notes in Grey Formation & Divisions of the Brachial Plexus ⤞ It’s formed in the posterior triangle of the neck. ⤞ Formed by the union of the anterior rami (ventral) of following spinal nerves: C5 C6 C7 C8 T1 ⤞ Then, divisions (stages) begin in the following order: ⤷ Roots (Above the clavicle, in the posterior triangle of the neck) ⤷ Trunks (Above the clavicle, in the posterior triangle of the neck) ⤷ Divisions (Behind the clavicle) ⤷ Cords (Below the clavicle, In the axilla. They’re named in relation to the axillary artery) ⤷ Terminal Branches (In the axilla) ⤞ mnemonic is: Rugby Teams Drinks Cold Beer 3 Course of Brachial Plexus The anterior Each trunk will divisions of the The posterior The anterior Roots of C5 & C6 Roots of C7 Roots of C8 & T1 branch into upper and divisions of division of the unite to form continues as the unite to form anterior and middle trunks three trunks lower trunk Superior trunk Middle trunk Inferior trunk posterior unite to form the unite to form the continues as the division Lateral cord. Posterior cord. Medial cord. Branches from Roots from upper Trunks from Lateral cord (3) from Medial Cord (5) from Posterior Cord (5) 1-Dorsal scapular 1- Suprascapular (2LM) (4MU) (ULTRA) nerve (C5) nerve (C5,C6) 1-Lateral pectoral nerve 1-Medial pectoral nerve 1-Axillary nerve. 2- Long thoracic 2- Nerve to subclavius 2-Musculocutaneous nerve 2-Ulnar nerve 2-Radial nerve nerve (C5,6,7) muscle (C5,C6) 3-Median nerve (lateral root) 3-Median nerve (medial root) 3-Upper subscapular nerve 4-Medial cutaneous nerve of arm 4-lower-subscapular nerves 5- Medial cutaneous nerve of arm forearm 5-Thoracodorsal 4 Brachial Plexus 5 Important branches and their supply (MSK flashback ) Branched from Branch name Supply Dorsal scapular nerve (C5) Rhomboideus, levator scapulae muscles Roots Long thoracic nerve (C5, 6, 7) Serratus anterior Upper trunk Suprascapular nerve (C5, 6) Supraspinatus and infraspinatus muscles Lateral pectoral nerve (C5, 6, 7) Pectoralis major muscle Lateral cord Musculocutaneous nerve (C5, 6, 7) Anterior compartment of arm (Flexors of shoulder & elbow Upper subscapular nerve (C5, 6) Subscapularis muscle Thoracodorsal nerve (C6, 7, 8) Latissimus dorsi muscle Posterior cord Lower subscapular nerve (C5, 6) Subscapularis and teres major muscles Axillary nerve (C5, 6) Deltoid and teres minor muscles; Radial nerve (C5, 6, 7, 8; T1) Posterior compartment of arm & forearm & hand (Extensors of elbow, wrist & fingers) Medial pectoral nerve (C8; T1) Pectoralis major & minor Medial cord Ulnar nerve (C8; T1) Anterior compartment of forearm & hand (Flexors of wrist & fingers) Medial & Lateral cord Median nerve (C5, 6, 7, 8; T1) 6 Brachial Plexus Injuries Deformity Damage Result Appearance Nerves related to Erb-Duchenne Adducted arm, and Palsy extended & pronated humerus and it’s or Upper trunk (C5 & C6) forearm fractures Waiter’s tip (Can happen during position baby delivery) Lower trunk lesion (C8 & T1) Axillary Nerve: Either: it passes around the Complete claw hand. surgical neck which is a Klumpke’s Palsy (median & ulnar ns. affected) dangerous fracture Paralysis of the muscles or Partial claw hand. (Ulnar n. only affected) point, there’s a risk of supplied by the damaged Claw hand it’s injury. nerve Caused by falling from a height clutching at an object.The first thoracic nerve is usually torn. Radial Nerve: The nerve fibers from this segment run in the It passes through the ulnar and median nerves Partial Complete radial groove, which is also a common fracture Loss of flexion, point risking the nerve injury. Ape’s hand opposition & weak or abduction of the thumb Median nerve injury Ulnar nerve: Pointing index Loss of flexion of the Can happen in case of a finger index finger,paralysis of supracondylar fracture both FDS & FDP of the medial epicondyle where the Paralysis of of extensors nerve passes Wrist drop Radial nerve of wrist & fingers 7 Lumbar Plexus Formation: ⤞ it’s formed by union of the ventral rami of: 01 ⤷ L1, L2, L3 & most of L4 (The rest of L4 will form the sacral plexus) Site: ⤞ It’s located In the substance of psoas major muscle. (INSIDE it) 02 Branches: ⤞ Iliohypogastric & Ilioinguinal nerves → Supplies the anterior abdominal wall ⤞ Obturator nerve → Supplies the medial 03 compartment of the thigh ⤞ Femoral nerve → Supplies the anterior compartment of the thigh 8 Femoral Nerve Course Muscular branches Cutaneous branches branch from lumbar plexus In abdomen: To iliacus (flexor of To antero-medial aspects of the L2,3,4 hip joint). thigh. Descends lateral to psoas major In lower limb: To anterior To medial side of knee, leg and muscle & enters the thigh behind compartment of thigh: foot (saphenous nerve) the inguinal ligament. To flexors of hip joint: sartorius It passes lateral to the femoral & pectineus. artery & divides into terminal To extensors of knee joint: branches. quadriceps femoris Femoral Nerve injury ⤞ Loss of sensation over ⤞ Wasting of quadriceps antero-medial aspect of thigh & Sensory effect femoris medial side of leg & foot (areas ⤞ Loss of knee extension supplied by the femoral nerve, ⤞ Weak flexion of the hip. Injury of the saphenous branch Motor effect (Psoas major is intact, of femoral nerve which supplies because it’s supplied by other the leg & foot) fibers of the lumbar plexus) 9 Sacral Plexus ⤞ Formation: ⤷ it’s formed by the ventral rami of a part of L4 & whole of L5 (Lumbosacral trunk)*, S1, S2, S3, and most of S4. ⤞ Site ⤷ Located in front of piriformis muscle. ⤞ Main Branches 1 2 3 Pelvic Splanchnic nerve Pudendal nerve Sciatic nerve ⤞ From the sacral Plexus (S2,3 & 4) ⤞ From the sacral Plexus (S2,3 & 4) ⤞ From the lumbosacral plexus ⤞ Preganglionic parasympathetic ⤞ Supplies the perineum . (L4, L5, S1, S2 & S3) supply to: ⤞ Supplies the lower limb ⤞ Pelvic Vescera ⤞ Hindgut *The lumbosacral trunk comprises the whole of the anterior division of the fifth and a part of that of the fourth lumbar nerve. 10 Sciatic Nerve To avoid an injury during an IM injection, it should be ⤞ Origin: given in the upper lateral ⤷ From L4, L5, S1, S2 & S3 quadrant of either gluteal ⤷ A terminal branches of the sacral plexus regions. Course Branches into Leaves the pelvis through All leg & foot EXCEPT areas supplied by the Cutaneous greater sciatic foramen saphenous n. from femoral n. (below piriformis) To Hamstring (knee flexion & hip extension Passes the gluteal region between ischial tuberosity & Muscular greater trochanter To all muscles of the leg then to the posterior Common peroneal (Fibular) nerve compartment of the thigh Terminal branches Tibial nerve Motor Injuries: Sensory Injuries: ⤞ Wasting of muscles below knee. (affect the flexion of ⤞ Loss of sensation below the knee EXCEPT the medial knee, extension of hip, all movements of leg & foot) side of leg & foot (supplied by femoral n.) ⤞ Foot assumes “foot drop” position by it’s weight. 11 Tibial & Common Peroneal (Fibular) Nerves Common Fibular nerve Tibial Nerve Course Course Leaves the popliteal fossa Descends through the popliteal fossa to the posterior turns around the lateral aspect compartment of the leg of the fibula’s neck (A dangerous position) It’s also accompanied with the posterior tibial vessels Divides into Passes deep to flexor retinaculum to reach the sole of the foot and divide. Superficial Deep peroneal peroneal Divides into Descends into the Descends into the lateral compartment of anterior compartment Medial planter Lateral planter the leg. of the leg. nerve nerve Muscles of anterior & lateral compartments of Muscles of posterior compartment of leg & Supplies leg (Dorsiflexors of ankle, Extensors of toes & Supplies intrinsic muscles of sole Plantar Flexors of evertors of foot. ankle, flexors of toes & invertors of foot. 12 Practice Q5: A patient came in with their arm hanging by the side, rotated medially and their Q1: All nerve fibers of the forming plexuses are the union of? forearm is extended and pronated. This lesion is called ___ and due to ___? A. Dorsal Rami A. Erb-Duchanne palsy | Middle trunk lesion B. Anterior Rami B. Klumpke palsy | Lower trunk lesion C. Ganglion C. Waiter’s tip hand | Upper trunk lesion D. Axilla D. Pope’s hand | Upper trunk lesion Q2: Which one of these deformities is the cause of median nerve lesion? Q6: Which of the following movement is affected by a common pernoeal nerve lesion? A. Waiter’s tip position A. Inversion of foot B. Ape hand B. Dorsiflexion of ankle C. Wrist drop C. Extension of knee D. Partial claw hand D. Flexion of toes Q3: Which of the following is a branch from the roots? Q7: The musculocutaneous nerve is a branch of the? A. Lateral pectoral nerve A. Lateral cord B. Nerve to subclavius B. Posterior cord C. Suprascapular nerve C. Medial cord D. Long thoracic nerve D. Upper trunk Q4: A young boy fell from a high place and clutched on something, which Q8 : The superficial peroneal nerve descends into the __ compartment of the leg? nerve is usually torn first? A. Anterior A. First thoracic B. Medial B. Ulnar nerve C. Posterior
Load more

Recommended publications
  • Anatomical Variants of the Musculocutaneous Nerve- Report of Two Cases
    Open Access CRIMSON PUBLISHERS C Wings to the Research Research in Anatomy ISSN: 2577-1922 Case Report Anatomical Variants of the Musculocutaneous Nerve- Report of Two Cases Fernando Martinez1,2 and Guzmán Ripoll1* 1Anatomy Department, Facultad de Medicina Universidad Claeh, Uruguay 2Neurosurgery Department, Universidad de la República, Uruguay *Corresponding author: Guzmán Ripoll, AnatomyDepartment, Facultad de Medicina Universidad Claeh, Maldonado, Uruguay, Email: Submission: February 22, 2018; Published: April 19, 2018 Abstract Introduction: The muscle-cutaneous nerve (MCN) is a mixed nerve, which is mainly responsible for shoulder flexion, elbow flexion and supinationMaterial of theand hand. method: The anatomical variations in this nerve are relatively frequent, fact with clinical and surgical implications. Results: Two variants were A retrospective found in the review 20 cases of 20studied patients (10% operated of the cases): on with anastomosis the Oberlin betweentechnique MCN was and made. median nerve, and absence of the MCN.Discussion: MCN variants are frequently described by the different authors. This has an embryological and phylogenetic explanation: the lateralConclusion: and medial cords form the flexor plane of the muscles of the upper limb. We present 2 cases: an unusual one of median nerve-MCN, and another absence of it. We emphasize that the knowledge of these variants have clinical, surgical and neuro-physiological applications. Introduction The musclecutaneous nerve (MCN) is a mixed nerve, which from basically the use of fascicles of the median nerve to reinforce the ulnar nerve (Figure 1). The modifications of this technique are the motor point of view is mainly responsible for shoulder flexion, brachial plexus injuries with involvement of the upper trunk (C5- the muscles that innervate: coracobrachial, biceps brachialis and anterior brachial muscle (Figure 2).
    [Show full text]
  • Anatomical Variations of the Brachial Plexus Terminal Branches in Ethiopian Cadavers
    ORIGINAL COMMUNICATION Anatomy Journal of Africa. 2017. Vol 6 (1): 896 – 905. ANATOMICAL VARIATIONS OF THE BRACHIAL PLEXUS TERMINAL BRANCHES IN ETHIOPIAN CADAVERS Edengenet Guday Demis*, Asegedeche Bekele* Corresponding Author: Edengenet Guday Demis, 196, University of Gondar, Gondar, Ethiopia. Email: [email protected] ABSTRACT Anatomical variations are clinically significant, but many are inadequately described or quantified. Variations in anatomy of the brachial plexus are important to surgeons and anesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. It is also important for radiologists who interpret plain and computerized imaging and anatomists to teach anatomy. This study aimed to describe the anatomical variations of the terminal branches of brachial plexus on 20 Ethiopian cadavers. The cadavers were examined bilaterally for the terminal branches of brachial plexus. From the 40 sides studied for the terminal branches of the brachial plexus; 28 sides were found without variation, 10 sides were found with median nerve variation, 2 sides were found with musculocutaneous nerve variation and 2 sides were found with axillary nerve variation. We conclude that variation in the median nerve was more common than variations in other terminal branches. Key words: INTRODUCTION The brachial plexus is usually formed by the may occur (Moore and Dalley, 1992, Standring fusion of the anterior primary rami of the C5-8 et al., 2005). and T1 spinal nerves. It supplies the muscles of the back and the upper limb. The C5 and C6 fuse Most nerves in the upper limb arise from the to form the upper trunk, the C7 continues as the brachial plexus; it begins in the neck and extends middle trunk and the C8 and T1 join to form the into the axilla.
    [Show full text]
  • Brachial-Plexopathy.Pdf
    Brachial Plexopathy, an overview Learning Objectives: The brachial plexus is the network of nerves that originate from cervical and upper thoracic nerve roots and eventually terminate as the named nerves that innervate the muscles and skin of the arm. Brachial plexopathies are not common in most practices, but a detailed knowledge of this plexus is important for distinguishing between brachial plexopathies, radiculopathies and mononeuropathies. It is impossible to write a paper on brachial plexopathies without addressing cervical radiculopathies and root avulsions as well. In this paper will review brachial plexus anatomy, clinical features of brachial plexopathies, differential diagnosis, specific nerve conduction techniques, appropriate protocols and case studies. The reader will gain insight to this uncommon nerve problem as well as the importance of the nerve conduction studies used to confirm the diagnosis of plexopathies. Anatomy of the Brachial Plexus: To assess the brachial plexus by localizing the lesion at the correct level, as well as the severity of the injury requires knowledge of the anatomy. An injury involves any condition that impairs the function of the brachial plexus. The plexus is derived of five roots, three trunks, two divisions, three cords, and five branches/nerves. Spinal roots join to form the spinal nerve. There are dorsal and ventral roots that emerge and carry motor and sensory fibers. Motor (efferent) carries messages from the brain and spinal cord to the peripheral nerves. This Dorsal Root Sensory (afferent) carries messages from the peripheral to the Ganglion is why spinal cord or both. A small ganglion containing cell bodies of sensory NCS’s sensory fibers lies on each posterior root.
    [Show full text]
  • Study of Brachial Plexus with Regards to Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 4 Ver. VII (Apr. 2016), PP 23-28 www.iosrjournals.org Study of Brachial Plexus With Regards To Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations. Dr. Shambhu Prasad1, Dr. Pankaj K Patel2 1 (Assistant Professor , Department of Anatomy , NMCH , Sasaram , India ) 2 (Assistant Professor , Department of Pathology , NMCH , Sasaram , India ) Abstract: Aim of the study: to search variations in formation and branching pattern of brachial plexus and correlate them with possible clinical and surgical implications. Materials and Methods: 25human bodies were dissected for this study. Dissection was started in posterior triangle of neck and extended to distal part of upper limb passing through axilla . Photographs were taken and data was tabulated and analyzed . Observations: All 50 plexuses had origin from C5 – T1 . Dorsal scapular nerve was absent in 2 plexuses. Long thoracic nerve was made of C5,C6 fibers in one and of C6,C7 fibers in another . Lower trunk was abnormal in 2 plexuses both of same body, their was no contribution from T1 fibers to posterior cord in one of these plexus. One plexus had double lateral pectoral nerve , communication between lateral and medial pectoral nerves , lateral pectoral and medial root of median nerve also between musculocutaneous and lateral root of median nerve . 2 more plexuses had communication between lateral and medial pectoral nerves. One plexus showed 2 branches coming from posterior division of upper trunk itself before formation of posterior cord.
    [Show full text]
  • Branching Pattern of the Posterior Cord of the Brachial Plexus: a Natomy Section a Cadaveric Study
    Original Article Branching Pattern of the Posterior Cord of the Brachial Plexus: natomy Section A A Cadaveric Study PRITI CHAUDHARY, RAJAN SINGLA, GURDEEP KALSEY, KAMAL ARORA ABSTRACT Results: normal branching pattern of the posterior cord was Introduction: Anatomical variations in different parts of the brachial encountered in 52 (86.67%) limbs, the remaining 8 (13.33%) being plexus have been described in humans by many authors, although variants in one form or the other. The upper subscapular nerve, these have not been extensively catalogued. These variations the thoracodorsal nerve and the axillary nerve were seen to arise are of clinical significance for the surgeons, radiologists and the normally in 91.66%, 96.66% and 98.33% of the limbs respectively. anatomists. The posterior division of the upper trunk being the parent of the variants of all these. The lower subscapular nerve had a normal In a study of 60 brachial plexuses which Material and Methods: origin in 96.66% of the limbs, with the axillary nerve being the belonged to 30 cadavers (male:female ratio = 28:02 ) obtained from parent in its variants, while the radial nerve had a normal origin the Department of Anatomy, Govt. Medical College, Amritsar, the in all of the limbs. Almost all the branches of the posterior cord brachial plexuses were exposed as per the standard guidelines. emanated distally on the left side as compared to the right side. The formation and the branching pattern of the posterior cord have been reported here. The upper subscapular, lower subscapular, Conclusion: The present study on adult human cadavers was an thoracodorsal and the axillary nerves usually arise from the posterior essential prerequisite for the initial built up of the data base at the cord of the brachial plexus.
    [Show full text]
  • Anastomotic Branch from the Median Nerve to the Musculocutaneous Nerve: a Case Report
    Case Report www.anatomy.org.tr Recieved: February 10, 2008; Accepted: April 22, 2008; Published online: October 31, 2008 doi:10.2399/ana.08.063 Anastomotic branch from the median nerve to the musculocutaneous nerve: a case report Feray Güleç Uyaro¤lu1, Gülgün Kayal›o¤lu2, Mete Ertürk2 1Department of Neurology, Ege University Faculty of Medicine, Izmir, Turkey 2Department of Anatomy, Ege University Faculty of Medicine, Izmir, Turkey Abstract Anomalies of the brachial plexus and its terminal branches are not uncommon. Communicating branch arising from the mus- culocutaneous nerve to the median nerve is a frequent variation, whereas the presence of an anastomotic branch arising from the median nerve and joining the musculocutaneous nerve is very rare. During routine dissection of cadaver upper limbs, we observed an anastomotic branch arising from the median nerve running distally to join with the branches of the musculocutaneous nerve in a left upper extremity. The anastomotic branch originated from the median nerve 11.23 cm prox- imal to the interepicondylar line. After running distally and coursing between the biceps brachii and the brachialis muscles, this anastomotic branch communicated with two branches of the musculocutaneous nerve separately. The presence of the communicating branches between these nerves should be considered during surgical interventions and clinical investigations of the arm. Key words: anatomy; brachial plexus; communicating branch; upper limb; variation Anatomy 2008; 2: 63-66, © 2008 TSACA Introduction neous nerve (C5, C6, and C7) connects with the median nerve in the arm.2,3 The musculocutaneous nerve is the Variations of the brachial plexus and its terminal continuation of the lateral cord of the brachial plexus.
    [Show full text]
  • Anatomical Study of the Brachial Plexus in Human Fetuses and Its Relation with Neonatal Upper Limb Paralysis
    ORIGINAL ARTICLE Anatomical study of the brachial plexus Official Publication of the Instituto Israelita de Ensino e Pesquisa Albert Einstein in human fetuses and its relation with neonatal upper limb paralysis ISSN: 1679-4508 | e-ISSN: 2317-6385 Estudo anatômico do plexo braquial de fetos humanos e sua relação com paralisias neonatais do membro superior Marcelo Rodrigues da Cunha1, Amanda Aparecida Magnusson Dias1, Jacqueline Mendes de Brito2, Cristiane da Silva Cruz1, Samantha Ketelyn Silva1 1 Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil. 2 Centro Universitário Padre Anchieta, Jundiaí, SP, Brazil. DOI: 10.31744/einstein_journal/2020AO5051 ❚ ABSTRACT Objective: To study the anatomy of the brachial plexus in fetuses and to evaluate differences in morphology during evolution, or to find anatomical situations that can be identified as the cause of obstetric paralysis. Methods: Nine fetuses (12 to 30 weeks of gestation) stored in formalin were used. The supraclavicular and infraclavicular parts of the brachial plexus were dissected. Results: In its early course, the brachial plexus had a cord-like shape when it passed through the scalene hiatus. Origin of the phrenic nerve in the brachial plexus was observed in only one fetus. In the deep infraclavicular and retropectoralis minor spaces, the nerve fibers of the brachial plexus were distributed in the axilla and medial bicipital groove, where they formed the nerve endings. Conclusion: The brachial plexus of human fetuses presents variations and relations with anatomical structures that must be considered during clinical and surgical procedures for neonatal paralysis of the upper limbs. How to cite this article: Cunha MR, Dias AA, Brito JM, Cruz CS, Silva Keywords: Brachial plexus/anatomy & histology; Fetus/abnormalities; Paralysis SK.
    [Show full text]
  • Bilateral Presence of a Variant Subscapularis Muscle
    CASE REPORT Bilateral presence of a variant subscapularis muscle Krause DA and Youdas JW Krause DA, Youdas JW. Bilateral presence of a variant subscapularis the lateral subscapularis inserting into the proximal humerus with the tendon of muscle. Int J Anat Var. 2017;10(4):79-80. the subscapularis. The axillary and lower subscapular nerves coursed between the observed muscle and the subscapularis. The presence of the muscle has potential ABSTRACT to entrap the axillary nerve and the lower subscapular nerve. We describe the presence of an accessory subscapularis muscle observed bilaterally Key Words: Accessory subscapularis; Axillary nerve; Lower subscapular nerve; in a human anatomy laboratory. The muscle originated from the mid-region of Entrapment INTRODUCTION everal anatomic variations in axillary musculature have been reported (1- S4). One of the more common variations is the axillary arch muscle, also known as Langer’s muscle, the axillopectoral muscle, and the pectordorsal muscle (3,4). This muscle typically arises from the lateral aspect of the latissimus dorsi inserting deep to the pectoralis major on the humerus. Several variations of the axillary arch muscle are described with a reported incidence of 6-9% (4-6). Less frequent and distinctly different than the axillary arch muscle, is a variant muscle associated with the subscapularis. This has been termed the subscapulo-humeral muscle, subscapularis minor, subscapularis-teres-latissimus muscle, and the accessory subcapularis muscle (1,2,7). Reported incidence ranges from 0.45 to 2.6% (2,7). CASE REPORT A variant muscle associated with the subscapularis bilaterally was observed on a Caucasian female embalmed cadaver during routine dissection in a human anatomy class for first year physical therapy students.
    [Show full text]
  • Risk of Encountering Dorsal Scapular and Long Thoracic Nerves During Ultrasound-Guided Interscalene Brachial Plexus Block with Nerve Stimulator
    Korean J Pain 2016 July; Vol. 29, No. 3: 179-184 pISSN 2005-9159 eISSN 2093-0569 http://dx.doi.org/10.3344/kjp.2016.29.3.179 | Original Article | Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Wonkwang Institute of Science, Iksan, *Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, University of Seonam College of Medicine, Jeonju, Korea Yeon Dong Kim, Jae Yong Yu*, Junho Shim*, Hyun Joo Heo*, and Hyungtae Kim* Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%).
    [Show full text]
  • Bilateral Anatomical Variation in the Formation of Trunks of the Brachial Plexus - a Case Report
    THIEME Case Report 9 Bilateral Anatomical Variation in the Formation of Trunks of the Brachial Plexus - A Case Report E.F. Lasch1 M.B. Nazer1 L.M. Bartholdy1 1 Laboratório de Anatomia Humana, Departamento de Biologia e Address for correspondence E. F. Lasch, Laboratório de Anatomia Farmácia, Universidade Santa Cruz do Sul – UNISC, Santa Cruz do Sul, Humana, Departamento de Biologia e Farmácia, Universidade Santa RioGrandedoSul,Brazil Cruz do Sul – UNISC, Av Independência, 2293, CEP 96815-900, Santa Cruz do Sul, RS, Brazil (e-mail: [email protected]). J Morphol Sci 2018;35:9–13. Abstract This study presents a bilateral variation in the formation of trunks of brachial plexus in a male cadaver. The right brachial plexus was composed of six roots (C4-T1) and the left brachial plexus of five roots (C5-T1). Both formed four trunks thus changing the contributions of the anterior divisions of the cervical nerves involved in the formation Keywords of the cords and the five main somatic motor nerves for the upper limb. There are very ► brachial plexus few case reports in the scientific literature on this topic; thus making the present study ► trunks very relevant. Introduction medial and lateral pectoral nerve, arise from the cords and innervate the shoulder muscles. The long infraclavicular Most of the upper limb nerves arise from by the brachial branches, which extend longitudinally to the upper limb, plexus (BP), which has a complex anatomical structure that are: the radial nerve, the ulnar nerve, and the median begins in the root of the neck and extends to the axilla nerve.4,5 (armpit region).
    [Show full text]
  • Muscle Attachment Sites in the Upper Limb
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Muscle Attachment Sites in the Upper Limb The Clavicle Pectoralis major Smooth superior surface of the shaft, under the platysma muscle Deltoid tubercle: Right clavicle attachment of the deltoid Deltoid Axillary nerve Acromial facet Trapezius Sternocleidomastoid and Trapezius innervated by the Spinal Accessory nerve Sternocleidomastoid Conoid tubercle, attachment of the conoid ligament which is the medial part of the Sternal facet coracoclavicular ligament Conoid ligament Costoclavicular ligament Acromial facet Impression for the Trapezoid line, attachment of the costoclavicular ligament Subclavian groove: Subclavius trapezoid ligament which binds the clavicle to site of attachment of the Innervated by Nerve to Subclavius which is the lateral part of the the first rib subclavius muscle coracoclavicular ligament Trapezoid ligament This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Scapula Trapezius Right scapula: posterior Levator scapulae Supraspinatus Deltoid Deltoid and Teres Minor are innervated by the Axillary nerve Rhomboid minor Levator Scapulae, Rhomboid minor and Rhomboid Major are innervated by the Dorsal Scapular Nerve Supraspinatus and Infraspinatus innervated by the Suprascapular nerve Infraspinatus Long head of triceps Rhomboid major Teres Minor Teres Major Teres Major
    [Show full text]
  • Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies
    Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies a, b Leo H. Wang, MD, PhD *, Michael D. Weiss, MD KEYWORDS Radial Posterior interosseous Neuropathy Electrodiagnostic study KEY POINTS The radial nerve subserves the extensor compartment of the arm. Radial nerve lesions are common because of the length and winding course of the nerve. The radial nerve is in direct contact with bone at the midpoint and distal third of the humerus, and therefore most vulnerable to compression or contusion from fractures. Electrodiagnostic studies are useful to localize and characterize the injury as axonal or demyelinating. Radial neuropathies at the midhumeral shaft tend to have good prognosis. INTRODUCTION The radial nerve is the principal nerve in the upper extremity that subserves the extensor compartments of the arm. It has a long and winding course rendering it vulnerable to injury. Radial neuropathies are commonly a consequence of acute trau- matic injury and only rarely caused by entrapment in the absence of such an injury. This article reviews the anatomy of the radial nerve, common sites of injury and their presentation, and the electrodiagnostic approach to localizing the lesion. ANATOMY OF THE RADIAL NERVE Course of the Radial Nerve The radial nerve subserves the extensors of the arms and fingers and the sensory nerves of the extensor surface of the arm.1–3 Because it serves the sensory and motor Disclosures: Dr Wang has no relevant disclosures. Dr Weiss is a consultant for CSL-Behring and a speaker for Grifols Inc. and Walgreens. He has research support from the Northeast ALS Consortium and ALS Therapy Alliance.
    [Show full text]