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Brachial Plexus Part II (no Part I)
Unit 4 - Lecture 3 - Axilla and Brachial Plexus - Dr. Berg - SUNY Upstate - Fall 2011
49
Anatomy
Graduate
11/17/2011

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Term
Localization of Nerve Lesions, Name 3 types
Definition
Paralysis, Anesthesia, Parasthesia
Term
I. Types of Paralysis
Definition
Flaccid and Spastic
Term
Flaccid Paralysis due to loss of ...nerve
Definition
Peripheral nerve (muscle becomes soft and can't contract). Cell bodies --> Lower motor neuron (ventral gray rami)
Term
Spastic Paralysis due to damage of?
Definition
Upper motor neuron lesion (brain). Muscle becomes hard and loses function
Term
II. Describe Anesthesia
Definition
numbness (complete sensory damage)
Term
III. Parasthesia
Definition
tingling => partial sensory damage
Term
Define Dermatome
Definition
Dermatome: skin supplied by a specific spinal nerve
Term
Define Myotome
Definition
The primary spinal nerve that contributes motor axons to that muscle constitutes the myotome of that muscle.
Term
Example of myotome
Definition
Axillary nerve --> deltoid muscle.
C5 = Primary Spinal nerve of axillary n.
C5 = MYOTOME of the deltoid muscle.
C5 lesion = C5 myotome muscles --> very weak (weak shoulder)
Term
Define Lesion
Definition
Damage or injury to peripheral nerve.
Term
3 Causes of a lesion
Definition
Metabolic prob, infection, trauma.
Term
Damaged structure can be...?
Definition
I. Spinal cord
II. Spinal nerve root (dorsal or ventral) and/or spinal nerve (both d/v)
III. Rami (ventral/dorsal)
Term
Complete lesion (cut nerve) --> ?
Definition
flaccid paralysis & loss of sensation of region
Term
Incomplete lesion (entrapment of nerve) --> ?
Definition
Parasthesia & weak muscles
Term
Radiculopathy is lesion to?
Definition
dorsal/ventral ROOT
Term
Radiculopathy example
Definition
herniated intervertebral disc (nucleus pulposus)--> less sensation from dermatome & muscle weakness
Term
I. SPINAL CORD lesions are usually caused by?
Definition
Trauma (i.e. fracture of vertebrae --> nerve lesion --> inferior/distal spinal nerves can't function)
Term
Give an example of a Spinal Cord lesion
Definition
damage C5 --> all spinal nerves BELOW C5 can't function. C5 dermatome and myotome still FUNCTIONS!
Term
Spinal segment vs. Vertebral Level
Definition
Spinal Segment = spinal cord region in which a SPECIFIC spinal nerve is attached. 31 segments = 31 PAIRS of spinal nerves. Spinal cord ends around L1/L2 in ADULT (recall embryology!)
Vertebral level = specific vertebra
Term
Why are lower lumbar injuries unlikely to cause spinal cord damage?
Definition
Spinal cord ends around L1/L2!
Term
dorsal root of spinal nerve has what fiber?
Definition
Somatic SENSORY (memorize how --> dorSal)
Term
Ventral root...?
Definition
Somatic MOTOR
Term
Spinal nerve has what fibers?
Definition
BOTH MOTOR and SENSORY [somatic]
Term
II. Again, what is a radiculopathy?
Definition
lesion of spinal ROOT! Thus either dorsal root (somatic sensory) OR ventral root (somatic motor) damage!
Term
Give example of radiculopathy to C5 Dorsal root
Definition
intervertebral disc herniation --> compression of C5 dorsal root --> loss of sensation and/or parasthesia from skin of C5 dermatome (posterior and lateral arm => axillary and radial nerves)
Term
Would other portions of arm be affected by a radiculopathy of C5 dorsal root? Explain
Definition
No, because the other regions of the arm are not derived from the C5 spinal nerve.
Term
Give example of radiculopathy to C5 Ventral root (motor)
Definition
Axillary n => C5, C6.
Delotoid weak, but still partially functions b/c of C6
Note: See Chart 5 (pg 179) for more Radiculopathy
Term
Lesions of BRACHIAL PLEXUS often result from...?
Definition
Trauma. Important to LOCALIZE the lesion (what nerves involved, etc)
Term
Lesion to branch of brachial plexus -->?
Definition
1) FLACCID Paralysis (lower motor neuron, in spinal cord, not brain which is a Spastic paralysis)
2) loss of sensation
Term
What is Erb's Palsy?
Definition
Lesion of C5 and C6 roots (upper roots)
Motor/sensory deficits to:
1) Posterior and lateral ARM
2) Lateral Forearm
3) Radial side of hand
Muscles (scapula, shoulder, elbow and wrist) paralyzed
Term
What are the muscles of Scapula, Shoulder, elbow, and wrist affected by Erb's palsy (C5, C6 spinal root lesion)
Definition
1) Subscapularis m (Upper/Lower Subscapular n.n.)
2) Rhomboids m. (Dorsal Scapular n.)
3) Extensor Carpi Radialis Longus/Brevis m.m. (Both via Radial n.)
4) Supinator (Radial)
5) Brachioradialis (Radial n)
6) Deltoid (Axillary n)
7) Teres Minor (Axillary n)
8) Biceps (Musculocutaneous n)
9) Brachialis (Musculocutaneous n)
10) Supraspinatous m (suprascapular n)
11) Infraspinatous m (suprascapular n)
Will revisit them later on!
Term
What are the only muscles left over that work on the shoulder for an Erb's Palsy patient?
Definition
Pectoralis major/minor m.m., latissimus dorsi, and teres major
Term
What position is the wrist of an Erb's palsy patient? Explain
Definition
In a FLEXED position. Why? --> C5 and C6 innervated Extensor carpi radialis longus/brevis m.m.
Term
What are the "Lower Roots" of the Brachial Plexus?
Definition
C8, T1
(Lesions here are less common)
Term
C8 and T1 lesions lead to ? palsy?
Definition
Klumpke's Palsy
Term
Discuss C8 and T1 dermatome
Definition
Sensory innervation from:
Medial Hand
Medial Forearm
Medial Side of Arm
Term
Discuss C8 and T1 myotome
Definition
Motor innervation to:
All intrinsic muscles of digits
Term
Chart 1- Brachial Plexus Lesions cards follow. Describe (1) Motor and (2) Sensory Deficit for each nerve lesion
Term will have Nerve (spinal segment) and where the nerve branches from (=> means "came from" like in orgo)
Definition
Press Space
Term
Long Thoracic N. (C5,6, 7 ventral rami)
Definition
1. Motor --> Serratus Anterior m. --> Winged Scapula
2. No Sensory
Term
Suprascapular n. (C5,C6) => Superior TRUNK
Definition
1) Motor --> Supra/infraspinatus m.m.
Supraspinatus deficit = can't start abduction
Infraspinatus deficit = can't externally rotate shoulder
2) No Sensory
Term
Axillary n. (C5) => Posterior Chord
Definition
1) Motor Deficit -> Deltoid, hard to abduct to shoulder level.
2) Sensory Deficit -> point of shoulder
Term
Musculocutaneous n. (C5, C6, C7) => Lateral Cord
Definition
1) Motor deficit -> Biceps, Brachialis, Weak ELBOW flexion
2) Radial (lateral) forearm
Term
Radial n. (C5,6,7,8) => Posterior cord
Definition
1) Motor deficit -> Extensor muscles, drop wrist
2) Sensory deficit: Back of hand on radial (lateral) side
Term
Median n. at Elbow (Pronator Teres Syndrome)
Median n = C6,7,8,T1
Definition
1) Motor deficits to:
a) Wrist flexors
b) Digit flexors
c) Thenar muscles - Ape Thumb (can't oppose thumb)
Result: Hand of Benediction (gun hand)
2) Sensory deficits: Palmar surface on Radial side
Term
Median n. at Wrist (Carpal Tunnel Syndrome)
Median n = C6,7,8,T1
Definition
1) Motor deficit: Thenar muscles (Ape thumb-can't oppose thumb)
2) Sensory deficits: Palmar surface on Radial side
Recall: Median nerve covers the ANTERIOR compartment of forearm and most of hand (palmar).
Term
Ulnar n. (C8,T1) at ELBOW causes which syndrome?
Definition
Cubital Tunnel Syndrome (Banging Funny Bone)
Term
Cubital Tunnel Syndrome (ulnar n. at elbow)
Definition
1) Motor deficits:
a) Weak ADDUCTION of wrist
b) Abduct/Adduct fingers
c) HyperABducted thumb
d) "Clawing" of 3rd and 4th fingers

2) Sensory deficit: ulnar side of hand (palm and dorsal surfaces)
Term
Ulnar nerve passes which tunnel in Hand?
Definition
Guyon Tunnel
Term
Ulnar n. (C8, T1)
Definition
1) Motor deficits:
a) Abduct and Adduct fingers
b) HyperABducted thumb
c) "Clawing" of 3rd and 4th fingers
2) NO SENSORY DEFICIT!
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