Summary of Nerves and Vessels of Upper limb

Summary of Nerves and Vessels of U pper limb. . itm.

Objectives. Describe as a summary, nerves of the upper limb with respect to their origin, course, distribution and termination Describe the vessels of upper limb with respect to their origin, course, distribution and termination Understand the clinical significance of their course and relations-e.g. sites of peripheral arterial pulsations Sites where nerves or vessels can be compressed or injured and the consequences of injury..

Branches of Brachial plexus from roots and upper trunk.

Musculocutaneous N.( C5,6,7). Muscular branches Biceps Brachialis Coracobrachialis Cutaneous Continues as-lateral cutaneous nerve of forearm Effects of Injury? Loss of flexion at elbow-hence arm in EXTENDED POSITION W eakened supination due to ( loss of biceps). Hence forearm held in? PRONATED position.

Axillary nerve. How and where can it be injured? In Upper trunk ( C5, C6) injuries In fractures of the surgical neck of the humerus Inferior dislocations of shoulder joint Effect of injury? Motor effect : Loss of ABDUCTION at Shoulder joint due to paralysis of Deltoid. Hence arm will be Adducted Loss of LATERAL ROTATION at Shoulder joint due to paralysis of Teres minor. Hence arm will be medially rotated Sensory loss ? Which area? ( figure).

Erb -Duchenne palsy: injury to UPPER trunk ( C5, C6) of BP.

Path of radial nerve OMMG. Radial Supinator muscle.

Image result for cutaneous distribution of radial nerve images.

Radial nerve( C5,6,7,8,T1). . . How and where can it be injured ? In axilla- e.g pressure of a badly fitting crutch In fractures of mid shaft of humerus-radial nerve in spiral ( radial) groove Effect on injury ? Depends on site E.g. Fracture of mid shaft of humerus : Loss of extension at WRIST joint and other distal joints: WRIST DROP Triceps is NOT affected! Why? Branches given out higher in axilla - hence escape.

Median nerve ( C5,6,7,8,T1). Branches: Muscular : Forearm : All flexors of forearm EXCEPT: Flexor carpi ulnaris M edial half of Flexor digitorum profundus Hand : All Thenar muscles EXCEPT Adductor pollicis 1 st , 2 nd lumbricals Cutaneous: see figure.

Carpal tunnel Syndrome. . Contents: Long flexor tendons M edian nerve Median nerve can be compressed in the carpal tunnel. Effects of pressure on median nerve? Which structures pass superficial to carpal tunnel ?.

Carpal tunnel syndrome. newe is compress at the wrist, resulting numbrrss or pain Carpal Tunnel yndrome.

Ulnar Nerve ( C8, T1)( musician’s nerve). Note close relation to medial epicondyle of humerus (in cubital tunnel) Branches: Muscular Forearm: FCU + medial half of FDP Hand: Hypothenar muscles ( abductor, flexor and opponens digiti minimi ) 3 rd ,4 th lumbricals ALL interossei A dductor pollicis Cutaneous.

Sma l l musc l es of hand. P A D P a lmar A D d uct at MP Joints.

FCU (Humeral Head) Cub ital FCU (Ulnar Head). Course of Ulnar nerve at elbow, forearm and hand.

Ulnar nerve-injury and effects. Effects of injury ? Paralysis of hypothenar muscles Paralysis of 3,4 lumbricals All interrossei (paper test ) L oss of flexion at MP joint Loss of extension at IP—hence MP joints HYPEREXTENDED and IP joints flexed ( digit flexors are normal) CLAW hand deformity.

Klumpke’s palsy-Injury to lower trunk of BP ( C8, T1).

13 09. Summary of Nerve Injuries. Radial nerve injury.

13 12. Dermatomes. . . Area of skin supplied by ONE segment For assessing sensory loss Dermatomes of Upper Limb S ome areas of overlap exist between adjacent dermatomes For loss of sensation to manifest, at least 3 spinal segments are likely to be affected.