DOCSLIB.ORG

Axillary and Median Nerve

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Axillary and Median Nerve Axillary and Median Nerve Musculoskeletal block - Anatomy - lecture 6 Editing file Color guide : Only in boys slides in Blue Objectives Only in girls slides in Purple important in Red By the end of the lecture, students should be able to: Doctor note in Green Extra information in Grey ✓ Describe the origin, course, relations, branches and distribution of the axillary & median nerves ✓ Describe the common causes and effects of injury to the axillary and median nerves Brachial plexus Remember To Drink Cold Beer Axillary Nerve Origin Course Branches (C 5 & 6) - It passes inferiorly and Posterior cord of laterally along the brachial plexus. posterior wall of the axilla to exit. أي ﻋﺻب ﻧﺎﺧذه ﻻزم ﻧﻌرف ﻣن أي ﻗطﻊ ﻣن اﻟﺳﺑﺎﯾﻧل ﻛورد ﺟﺎء ، ﻷن أي ﺿرر ﯾﺻﯾر ﻓﯾﮭم ھو أﯾﺿﺎً راح ﯾﺗﺄﺛر. -Then, it passes posteriorly (Motor) (Sensory) around the surgical neck of to the deltoid and superior lateral cutaneous the humerus. teres minor nerve of arm that loops muscles. around the posterior -It is accompanied by the margin of the deltoid posterior muscle to innervate skin in circumflex humeral artery. that region. Axillary Nerve Lesions affects The axillary nerve is usually injured due to: ● Fracture of surgical neck of the humerus Motor: Sensory: ● Downward 1- Impaired abduction of the shoulder (15-90˚) Loss of dislocation of the Note: the patient CANNOT raise his arm over 30˚. sensation shoulder joint 2- Paralysis of the deltoid and teres minor over the lateral muscles side of the (The paralyzed deltoid wastes rapidly proximal part As the deltoid atrophies, the rounded contour of the of the arm. ● Compression from shoulder is flattened compared to the uninjured the incorrect use side). of crutches Median Nerve Origin (C5,6,7, 8, T1) The median nerve is formed anterior to the third part of the axillary artery by the union of lateral and medial roots • The lateral root (C5,6&7), arises from the lateral cord of the brachial plexus. • The medial root (C8 & T1), arises from the medial cord of the brachial plexus. originating from the lateral and medial cords of the brachial plexus. Note: Axillary artery is named Brachial artery when it reaches the arm Median Nerve In the arm Note that It enters the arm from the axilla at the ● The median nerve has NO inferior margin of the teres major major branches in the arm muscle. or axilla, but a branch to It passes vertically down the medial Brachial artery side of the arm in the anterior one of the muscles of the compartment and is related to the forearms, the (Pronator brachial artery throughout its course: Teres), this branch may ● In proximal regions (In upper 1⁄2 of the originate from the nerve arm), it lies immediately lateral to the immediately proximal to brachial artery. the elbow joint. ● In more distal regions (In the middle of the arm), it crosses the medial side of the brachial artery. ● In the lower 1⁄2 it descends on the medial side of the brachial artery. ● It descends anterior to the elbow joint. Note: Flexor retinaculum is a fibrous tissue: Retinaculum = Deep fascia flexor = in the middle Median Nerve In the forearm In the hand Median nerve passes into the The median nerve continues into the forearm anterior to the elbow hand by passing deep to the flexor joint(between the 2 heads of retinaculum. It innervates: pronator teres) where it branches innervates most ● Three thenar eminence muscles of the muscles in the anterior associated with the thumb. compartment of the forearm (6.5 ● Lateral two lumbrical muscles muscles) Except the: associated with movement of ● Flexor Carpi Ulnaris the index and middle finger. ● the medial half of the Flexor ● Skin over the palmar surface of Digitorum Profundus the lateral three and one- half (which are innervated by the digits and over the lateral side ulnar nerve). of the palm and middle of the wrist. (The lateral 2/3rd of the palm of the hand.) Median Nerve Lesions Injury of the median nerve at different levels causes different syndromes - In the arm and forearm the median nerve is usually not injured by trauma, why ? Because of its relatively deep position. Sites of damage Serious effects Loss of opposition of the Loss of sensation: thumb: from the thumb and lateral 3½ In the carpal tunnel (deep The delicate pincer- like action fingers & lateral ⅔ of the palm. in the flexor retinaculum) is not possible. اﺧﻄﺮ ﺷﻲ ﻻن ﻣﺎ ﻓﻲ ﻋﻀﻠﺔ ﺛﺎﻧﯿﺔ ﺗﺴﻮي ﻧﻔﺲ اﻟﺤﺮﻛﺔ أو ﻋﺼﺐ ﺛﺎﻧﻲ ﯾﻌﻮض At the wrist above the flexor retinaculum In the elbow region (supracondylar fracture of the humerus) Lesion About Motor Sensory and tropic ● Loss of pronation. Sensory: ● Hand is kept in supine position. Loss of sensation from: ● Wrist shows weak flexion, and ● The radial side ⅔ of the ulnar deviation. (cause there is no muscle to antagonise the action of the ulnaris) palm. ● Loss of flexion on the ● Palmar aspect of the interphalangeal joints of the lateral 3½ fingers. Damaged in supracondylar fracture of index and middle fingers. ● Distal part of the dorsal Median humerus ● Weak flexion of ring and little surface of the lateral 3½ Nerve Muscles affected are: fingers. ● Thumb is adducted (cause the fingers. adductor muscle is not supplied by the median Lesion in ● Pronator muscles of the forearm (they nerve) and laterally rotated, with the Elbow will always be supinated) ● All long flexors of the wrist and loss of flexion of terminal Region phalanx and loss of opposition. fingers except flexor carpi ulnaris ● Wasting of thenar eminence. and medial half of flexor ● Hand looks flattened and “apelike”,and presents an Trophic Changes: digitorum profundus inability to flex the three most ● radial digits when asked to Dry and scaly skin make a fist. ● Easily cracking nails Supinator ● Atrophy of the pulp of The index and Flex.Dig. Pronator teres Superficialis middle fingers are the fingers extended because of Wasting of Flex.carpi the antagonist radialis thenar eminence muscle Extra Flex.pol.long us Flex.carpi ulnaris Lesion About Motor Sensory Often injured by penetrating wounds (stab Thenar muscles are Sensory: wounds or broken glass) of the forearm. Loss of sensation from: paralyzed and atrophy (ﻟﻤﺎ اﻟﺸﺨﺺ ﯾﺤﺎول ﯾﻨﺘﺤﺮ) Median Nerve happens with time so that ● The radial side of the palm. the thenar eminence ● Palmar aspect of the lateral Lesion at the NOTE: You have to know each deformity and becomes flattened. 3½ fingers. Wrist the muscles/nerves involved. ● Distal part of the dorsal Opposition and abduction surface of the lateral 3½ of thumb are lost, and fingers. thumb and lateral two fingers are arrested in Trophic Changes: adduction and hyperextension position. ● Dry and scaly skin ● Easily cracking nails “Apelike hand” ● Atrophy of the pulp of the fingers are the same as in the elbow region injuries. Median Nerve The most common neurological problem Weak motor function of Burning pain or ‘pins Lesion associated with the median nerve is the thumb, index & middle and needles’ along the distribution of median nerve to deep in flexor compression beneath the flexor retinaculum fingers. lateral 3½ fingers. retinaculum at the wrist. “Carpal Tunnel The symptoms first appear as sensory but Syndrome” No sensory changes over the palm when it progresses further the motor as the palmar cutaneous branch is symptoms appear. given before the median nerve enters the carpal tunnel. most common in postmenopausal women SUMMARY MCQs Question 1: The median nerve continues into the hand by passing deep to the? Question 5: Loss of pronation is a motor effect of: A. Flexor retinaculum A. Median nerve injury in elbow B. Brachialis B. Median nerve injury at the wrist C. Coracobrachialis C. Axillary nerve injury D. Extensor digitorum longus D. Median nerve injury in the carpal tunnel Question 2: The median nerve originate from: Question 6: A patient complaining of pins and needles sensation along the medial side of A. Lateral cord the upper limb and the 3 lateral fingers, that would indicate: B. Medial cord A.Median Nerve Lesion in the Elbow Region C. Both B & A B. Carpal tunnel syndrome D. Posterior cord C. Surgical neck fracture Question 3: Which one of the following is a sensory supply of the median nerve? D.Median Nerve Lesion at the wrist A. 3 thenar Muscles B. 3 hypothenar Muscles SAQ C. Palmer lateral 3 and a half digit D. Palmer medial 1 and a half digit Question 1: One of the trophic changes in Median Nerve Lesion in the Elbow Question 4: A physician examined an X ray and saw that the patient had a Region? fracture in the surgical neck, which nerve will he be worried about? Dry and scaly skin A. brachial B. Radial Question 2: Where are the axillary motor branches located? C. Musculocutaneous In the deltoid and teres minor muscles. D. Axillary Answers: Q1.A- Q2.C -Q3.C -Q4.D- Q5.A- Q6.B Team members Girls team : Boys team: ● Ajeed Al Rashoud ● Khalid AL-Dossari ● Taif Alotaibi ● Naif Al-Dossari ● Noura Al Turki ● Faisal Alqifari ● Amirah Al-Zahrani ● Salman Alagla ● Alhanouf Al-haluli Special thank for ● Ziyad Al-jofan ● Sara Al-Abdulkarem ● Suhail Basuhail ● Rawan Al Zayed Anatomy team 436 ● Ali Aldawood ● Reema Al Masoud ● Khalid Nagshabandi ● Renad Al Haqbani ● Mohammed Al-huqbani ● Nouf Al Humaidhi ● Jehad Alorainy ● Fay Al Buqami ● Khalid AlKhani ● Jude Al Khalifah ● Omar Alammari ● Nouf Al Hussaini ● Alwateen Al Balawi ● Rahaf Al Shabri ● Danah Al Halees Team leaders ● Haifa Al Waily ● Rema Al Mutawa ● Abdulrahman Shadid ● Amirah Al Dakhilallah Good luck ● Ateen Almutairi ● Maha Al Nahdi ● Renad Al Mutawa Give us your feedback: ● Ghaida Al Braithen ● Reham Yousef =This lecture done by.
Load more

Recommended publications
  • Redalyc.Variations in Branching Pattern of the Axillary Artery: a Study
    Jornal Vascular Brasileiro ISSN: 1677-5449 [email protected] Sociedade Brasileira de Angiologia e de Cirurgia Vascular Brasil Astik, Rajesh; Dave, Urvi Variations in branching pattern of the axillary artery: a study in 40 human cadavers Jornal Vascular Brasileiro, vol. 11, núm. 1, marzo, 2012, pp. 12-17 Sociedade Brasileira de Angiologia e de Cirurgia Vascular São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=245023701001 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative ORIGINAL ARTICLE Variations in branching pattern of the axillary artery: a study in 40 human cadavers Variações na ramificação do padrão da artéria axilar: um estudo em 40 cadáveres humanos Rajesh Astik1, Urvi Dave2 Abstract Background: Variations in the branching pattern of the axillary artery are a rule rather than an exception. The knowledge of these variations is of anatomical, radiological, and surgical interest to explain unexpected clinical signs and symptoms. Objective: The large percentage of variations in branching pattern of axillary artery is making it worthwhile to take any anomaly into consideration. The type and frequency of these vascular variations should be well understood and documented, as increasing performance of coronary artery bypass surgery and other cardiovascular surgical procedures. The objective of this study is to observe variations in axillary artery branches in human cadavers. Methods: We dissected 80 limbs of 40 human adult embalmed cadavers of Asian origin and we have studied the branching patterns of the axillary artery.
    [Show full text]
  • Intrinsic Hand Muscles of the Japanese Monkey, Macaca Fuscata
    Anthropol.Sci. 102(Suppl.), 85-95,1994 Intrinsic Hand Muscles of the Japanese Monkey, Macaca fuscata TOSHIHIKO HOMMA AND TATSUO SAKAI Department of Anatomy, School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, Tokyo 113, Japan Received December 24, 1993 •ôGH•ô Abstract•ôGS•ô Anatomy of the intrinsic hand muscles in the Japanese monkeys was studied with an improved method to dissect the muscles and nerves in water after removal of the skeletal framework. The thenar eminence contained four muscles, namely m. abductor pollicis brevis, m. opponens pollicis, m, flexor pollicis brevis, and m. adductor pollicis. The hypothenar eminence contained four muscles, namely m. palmaris brevis, m. abductor digiti minimi, m. flexor digiti minimi brevis, and m. opponens digiti minimi. Majority of the thenar muscles are fused more or less with each other, so that clear separation of these muscles was difficult. The lumbrical muscles arose from the palmar parts of four main tendons of the deep flexor muscle to the second, third, fourth, and fifth digits. The mm, contrahentes arose mainly from a medial tendinous septum attached on the palmar surface to the third metacarpus, and included three muscles destined to the second, fourth and fifth digits. The interossei were found on the radial side of the second, third, fourth and fifth finger as well as on the ulnar side of the second, third and fourth finger. The intrinsic hand muscles in the Japanese monkey received innervation either from the median or the ulnar nerve. Branching pattern of these nerves to the individual muscles was fundamentally similar to those in man except for the fact that the median and the ulnar nerve in the Japanese monkey do not communi cateto make a loop in the thenar muscles.
    [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]
  • 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]
  • Pronator Syndrome: Clinical and Electrophysiological Features in Seven Cases
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.5.461 on 1 May 1976. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry, 1976, 39, 461-464 Pronator syndrome: clinical and electrophysiological features in seven cases HAROLD H. MORRIS AND BRUCE H. PETERS From the Department ofNeurology, University of Texas Medical Branch, Galveston, Texas, USA SYNOPSIS The clinical and electrophysiological picture of seven patients with the pronator syndrome is contrasted with other causes ofmedian nerve neuropathy. In general, these patients have tenderness over the pronator teres and weakness of flexor pollicis longus as well as abductor pollicis brevis. Conduction velocity of the median nerve in the proximal forearm is usually slow but the distal latency and sensory nerve action potential at the wrist are normal. Injection of corticosteroids into the pronator teres has produced relief of symptoms in a majority of patients. Protected by copyright. In the majority of isolated median nerve dys- period 101 cases of the carpal tunnel syndrome functions the carpal tunnel syndrome is appropri- and the seven cases of the pronator syndrome ately first suspected. The median nerve can also reported here were identified. Median nerve be entrapped in the forearm giving rise to a conduction velocity determinations were made on similar picture and an erroneous diagnosis. all of these patients. The purpose of this report is to draw full attention to the pronator syndrome and to the REPORT OF CASES features which allow it to be distinguished from Table 1 provides clinical details of seven cases of the median nerve entrapment at other sites.
    [Show full text]
  • Wrist and Hand Examina[On
    Wrist and Hand Examinaon Daniel Lueders, MD Assistant Professor Physical Medicine and Rehabilitaon Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the wrist and hand • Outline evaluaon of and differen.aon between nerves to the wrist and hand • Describe special tes.ng of wrist and hand Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Inspec.on • Ecchymosis • Erythema • Deformity • Laceraon Inspec.on • Common Finger Deformies • Swan Neck Deformity • Boutonniere Deformity • Hypertrophic nodules • Heberden’s, Bouchard’s Inspec.on • Swan Neck Deformity • PIP hyperextension, DIP flexion • Pathology is at PIP joint • Insufficiency of volar/palmar plate and suppor.ng structures • Distally, the FDP tendon .ghtens from PIP extension causing secondary DIP flexion • Alternavely, extensor tendon rupture produces similar deformity Inspec.on • Boutonniere Deformity • PIP flexion, DIP hyperextension • Pathology is at PIP joint • Commonly occurs from insufficiency of dorsal and lateral suppor.ng structures at PIP joint • Lateral bands migrate volar/palmar, creang increased flexion moment • Results in PIP “buTon hole” effect dorsally Inspec.on • Nodules • Osteoarthri.c • Hypertrophic changes of OA • PIP - Bouchard’s nodule • DIP - Heberden’s nodule • Rheumatoid Arthri.s • MCP joints affected most • Distal radioulnar joint can also be affected
    [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]
  • Examination of the Shoulder Bruce S
    Examination of the Shoulder Bruce S. Wolock, MD Towson Orthopaedic Associates 3 Joints, 1 Articulation 1. Sternoclavicular 2. Acromioclavicular 3. Glenohumeral 4. Scapulothoracic AC Separation Bony Landmarks 1. Suprasternal notch 2. Sternoclavicular joint 3. Coracoid 4. Acromioclavicular joint 5. Acromion 6. Greater tuberosity of the humerus 7. Bicipital groove 8. Scapular spine 9. Scapular borders-vertebral and lateral Sternoclavicular Dislocation Soft Tissues 1. Rotator Cuff 2. Subacromial bursa 3. Axilla 4. Muscles: a. Sternocleidomastoid b. Pectoralis major c. Biceps d. Deltoid Congenital Absence of Pectoralis Major Pectoralis Major Rupture Soft Tissues (con’t) e. Trapezius f. Rhomboid major and minor g. Latissimus dorsi h. Serratus anterior Range of Motion: Active and Passive 1. Abduction - 90 degrees 2. Adduction - 45 degrees 3. Extension - 45 degrees 4. Flexion - 180 degrees 5. Internal rotation – 90 degrees 6. External rotation – 45 degrees Muscle Testing 1. Flexion a. Primary - Anterior deltoid (axillary nerve, C5) - Coracobrachialis (musculocutaneous nerve, C5/6 b. Secondary - Pectoralis major - Biceps Biceps Rupture- Longhead Muscle Testing 2. Extension a. Primary - Latissimus dorsi (thoracodorsal nerve, C6/8) - Teres major (lower subscapular nerve, C5/6) - Posterior deltoid (axillary nerve, C5/6) b. Secondary - Teres minor - Triceps Abduction Primary a. Middle deltoid (axillary nerve, C5/6) b. Supraspinatus (suprascapular nerve, C5/6) Secondary a. Anterior and posterior deltoid b. Serratus anterior Deltoid Ruputure Axillary Nerve Palsy Adduction Primary a. Pectoralis major (medial and lateral pectoral nerves, C5-T1 b. Latissimus dorsi (thoracodorsal nerve, C6/8) Secondary a. Teres major b. Anterior deltoid External Rotation Primary a. Infraspinatus (suprascapular nerve, C5/6) b. Teres minor (axillary nerve, C5) Secondary a.
    [Show full text]
  • Variations in the Branching Pattern of the Radial Nerve Branches to Triceps Brachii
    Review Article Clinician’s corner Images in Medicine Experimental Research Case Report Miscellaneous Letter to Editor DOI: 10.7860/JCDR/2019/39912.12533 Original Article Postgraduate Education Variations in the Branching Pattern Case Series of the Radial Nerve Branches to Anatomy Section Triceps Brachii Muscle Short Communication MYTHRAEYEE PRASAD1, BINA ISAAC2 ABSTRACT Results: The branching patterns seen were types A 1 (3.6%), Introduction: The axillary nerve arises from the posterior cord B1 (1st pattern) 1 (3.6%), B2 (2nd pattern) 1 (3.6%), and C3 of the brachial plexus and supplies the deltoid and teres minor 22 (78.6%). Two new patterns observed were: type B2 muscles. Axillary nerve injuries lead to abduction and external (6th pattern) 1 (3.6%) and type D (2nd pattern) 2 (7.1%). The long rotation weakness. In such cases, branches to the heads of head had single innervation in 89.3% cases and the lateral and triceps brachii muscle have been transferred to the axillary nerve medial heads had dual innervation in 10.7% and 7.1% cases to establish reinnervation of the deltoid muscle. In addition, the respectively. triceps nerve branches can be nerve recipients to reinstitute Conclusion: The knowledge of the different branching patterns elbow extension. that are present will help surgeons to identify the most suitable Aim: To study the different branching patterns of the radial radial nerve branch to triceps brachii that can be used for nerve nerve branches to triceps brachii muscle. transfer to restore the motor function of the deltoid muscle or to reanimate the triceps brachii muscle.
    [Show full text]
  • Multiple Nerve Injuries Following Repair of a Distal Biceps Tendon Rupture Case Report and Review of the Literature
    166 Bulletin of the Hospital for Joint Diseases 2013;71(2):166-9 Multiple Nerve Injuries Following Repair of a Distal Biceps Tendon Rupture Case Report and Review of the Literature Marc R. Fajardo, M.D., Zehava Rosenberg, M.D., Dimitrios Christoforou, M.D., and John A. I. Grossman, M.D., F.A.C.S. Abstract We present the case of a patient, with a surgically repaired Current repair of a distal biceps tendon rupture has reverted distal biceps tendon rupture performed through a single to the single incision technique. Postoperative complications incision, with injury to both the posterior interosseus and are rare, but the most common are due to neuropraxia. We lateral antebrachial cutaneous nerves. present the case of patient who sustained multiple nerve injuries following distal biceps repair. This case is presented Case Report with a review of the literature. A healthy, right-hand dominant 51-year-old man sustained injury to his right distal biceps while shoveling dirt. He was upture of the distal end of the biceps brachialis diagnosed with an acute right distal biceps rupture (con- tendon is a relatively uncommon injury that usually firmed by ultrasound, Fig. 1) and subsequently underwent Roccurs in active, middle-aged men after an eccentric operative repair within a week of the injury. muscle contracture (often during heavy lifting). Patients The surgery was performed via a single incision. Intra- often present with pain, ecchymosis, and swelling over operatively, it was found that 90% of the distal biceps ten- the antecubital region of the dominant arm. The physical don was avulsed from the radial tuberosity.
    [Show full text]
  • Pectoral Region and Axilla Doctors Notes Notes/Extra Explanation Editing File Objectives
    Color Code Important Pectoral Region and Axilla Doctors Notes Notes/Extra explanation Editing File Objectives By the end of the lecture the students should be able to : Identify and describe the muscles of the pectoral region. I. Pectoralis major. II. Pectoralis minor. III. Subclavius. IV. Serratus anterior. Describe and demonstrate the boundaries and contents of the axilla. Describe the formation of the brachial plexus and its branches. The movements of the upper limb Note: differentiate between the different regions Flexion & extension of Flexion & extension of Flexion & extension of wrist = hand elbow = forearm shoulder = arm = humerus I. Pectoralis Major Origin 2 heads Clavicular head: From Medial ½ of the front of the clavicle. Sternocostal head: From; Sternum. Upper 6 costal cartilages. Aponeurosis of the external oblique muscle. Insertion Lateral lip of bicipital groove (humerus)* Costal cartilage (hyaline Nerve Supply Medial & lateral pectoral nerves. cartilage that connects the ribs to the sternum) Action Adduction and medial rotation of the arm. Recall what we took in foundation: Only the clavicular head helps in flexion of arm Muscles are attached to bones / (shoulder). ligaments / cartilage by 1) tendons * 3 muscles are attached at the bicipital groove: 2) aponeurosis Latissimus dorsi, pectoral major, teres major 3) raphe Extra Extra picture for understanding II. Pectoralis Minor Origin From 3rd ,4th, & 5th ribs close to their costal cartilages. Insertion Coracoid process (scapula)* 3 Nerve Supply Medial pectoral nerve. 4 Action 1. Depression of the shoulder. 5 2. Draw the ribs upward and outwards during deep inspiration. *Don’t confuse the coracoid process on the scapula with the coronoid process on the ulna Extra III.
    [Show full text]
  • The Muscles That Act on the Upper Limb Fall Into Four Groups
    MUSCLES OF THE APPENDICULAR SKELETON UPPER LIMB The muscles that act on the upper limb fall into four groups: those that stabilize the pectoral girdle, those that move the arm, those that move the forearm, and those that move the wrist, hand, and fingers. Muscles Stabilizing Pectoral Girdle (Marieb / Hoehn – Chapter 10; Pgs. 346 – 349; Figure 1) MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: ANTERIOR THORAX: anterior surface coracoid process protracts & depresses Pectoralis minor* pectoral nerves of ribs 3 – 5 of scapula scapula medial border rotates scapula Serratus anterior* ribs 1 – 8 long thoracic nerve of scapula laterally inferior surface stabilizes / depresses Subclavius* rib 1 --------------- of clavicle pectoral girdle POSTERIOR THORAX: occipital bone / acromion / spine of stabilizes / elevates / accessory nerve Trapezius* spinous processes scapula; lateral third retracts / rotates (cranial nerve XI) of C7 – T12 of clavicle scapula transverse processes upper medial border elevates / adducts Levator scapulae* dorsal scapular nerve of C1 – C4 of scapula scapula Rhomboids* spinous processes medial border adducts / rotates dorsal scapular nerve (major / minor) of C7 – T5 of scapula scapula * Need to be familiar with on both ADAM and the human cadaver Figure 1: Muscles stabilizing pectoral girdle, posterior and anterior views 2 BI 334 – Advanced Human Anatomy and Physiology Western Oregon University Muscles Moving Arm (Marieb / Hoehn – Chapter 10; Pgs. 350 – 352; Figure 2) MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: intertubercular
    [Show full text]