1. BRACHIAL
PLEXUS
Aarushi Manu
50th Batch

2. Anatomy
 Roots
 Trunks
 Division
 Cord
 Branches
Sympathetic nerves of upper limb – T2
to T6 pass thru brachial plexus

3. Roots
 Ant. Primary rami of C5,6,7,8&T1
with cotribution from C4 & T2
 Prefixed or postfixed
Trunks
C5 & C6 upper trunk
C7 middle trunk
C8 & T1 lower trunk

4. Divisions
 Trunks divides into dorsal & ventral
divisions
Cords
Lateral cord – ventral division of upper
& middle trunks
Medial – ventral divisn of lower
trunk
posterior – dorsal division of all
trunks

5. Branches of Plexus
A. Branches of Roots
1.Long thoracic nerve – N to
serratus anterior (C5,6,7)
2. Dorsal scapular N. – N to
rhomboides (C5)
B. Branches of Trunks
1.Suprascapular N. (C5,6)
2. N. to subclavius (C5,6)

6. C.Branches of cords
(a) lateral cord
1. Lateral pectoral (C5-7)
2.Musculocutaneous(C5-7)
3.Lat. Root of median(C5-7)
(b) Medial cord
1.Medial pectoral (C8,T1)
2.Med. Cut. N. of arm(c8,T1)
3.Med. Cut. N. of forearm(C8,T1)

7. 4.Med. Root of median(C8,T1)
5.Ulnar N.(C7,C8,T1)
(c) Posterior cord
1.Upper subscapular(C5,6)
2.Lower subscapular(C5,6)
3.Axillary/circumflex(C5,6)
4.Thoracodorsal (C6,7,8)
N to latissmus dorsi
5.Radial N. (C5-8,T1)

9. Brachial Plexus Injuries
Causes
 Closed – birth trauma,bike trauma
 Open – gunshot
Types
 Preganglionic- Horners synd.
 Postganglionic

10. Investigation
 X-ray
 CT
 MRI
 Electrical studies – EMG,nerve
conductn study

11. Rx
Initial stages
1.Splinting
 Complete paralysis-Flail arm splint
 Incomplete – modified splints
2.pain control –TENS
3.Prevent contracture & deformities-
passive exercises

12. Later stages
1. Strengthen the ms-exercises,PNF
2. Re-educatn of ms-movt. Of
shoulder & stimulatn
3. Modify the splint & dynamise it
4. TENS for pain
5. Re-constructive surgery-after 2
yrs

13. Surgery
A/c phases
 preganglionic-no use
 postganglionic- suture or N.
grafting
Late phase >2yrs
 Shoulder fn- trapzius to humerus
to improve abductn
 Elbow fn- Steindler’s flexorplasy
 For wrist & finger extentn

14. Erb’s Palsy
 Site – Erb’s point
 Causes – Birth injury,Fall on
shoulder, Anaesthetia
 Nerve root – C5(mainly),C6(partly)
 Muscle paralysed-
biceps,deltoid,brachialis,
brachioradialis,supinator,supra-
&infraspinatus
 Deformity – policeman’s tip hand

16. Disability
 Abductn & lat. Rotatn of arm
 Flexion & supinatn of forearm
 Biceps & supinator jerks
 Sensatn over lower part of deltoid

17. Klumpke’s paralysis
 Cause –undue abductn of arm,birth
injury
 Nerve root- T1 & partly C8
 Muscles – intrinsic muscles of
hand(T1)& ulnar flexors of wrist and
hand(C8)
 Deformity – Claw hand

18. CLAW HAND

19.  Injury to N of Bell
winging of scapula

20. THANK U!!!