Kaan Yücel M.D., Ph.D. 02.April.2014 Wednesday

Corticospinal tract

Blue Motor Green Sensory

Spinal cord

http://encyclopedia.lubopitko-bg.com/The_Spinal_Cord.html

roots anterior rami of C5 to C8,

and most of T1 Superior trunk

union of C5 & C6 roots

Middle trunk continuation of C7 root

Inferior trunk union of C8 and T1 roots

Lateral cord C5-C7 anterior divisions of sup. & middle trunks Medial cord C8-T1 anterior division of inferior trunk Posterior cord C5-T1 Posterior divisions of all trunks

1) Superior subscapular nerve 2) Thoracodorsal nerve 3) Inferior subscapular nerve 4) Axillary nerve 5) Radial nerve

Posterior cord

1) Medial pectoral nerve 2) Medial cutaneous nerve of arm 3) Medial cutaneous nerve of

forearm 4) Ulnar nerve 5) Median nerve

Medial cord

1) Lateral pectoral nerve 2) Musculocutaneous nerve 3) Lateral root of median nerve

Lateral cord

1. AXILLARY NERVE

quadrangular space posterior circumflex humeral artery and vein @ posterior part of shoulder Teres minor muscle @ deltoid region Deltoid muscle superior lateral cutaneous

nerve of the arm skin over the inferior part of the deltoid muscle.

2. MUSCULOCUTANEOUS NERVE

o Pierces corachobrachialis.

o Between biceps brachii & brachialis

o Emerges lateral to the biceps brachii tendon @ the elbow

Lateral cutaneous nerve of forearm All muscles in the anterior compartment of the arm Biceps brachii Coracobrachialis Brachialis (except a small part by radial nerve

skin on the lateral surface of the forearm

3. MEDIAN NERVE

principal nerve of the anterior compartment of the forearm

o Leaves the cubital fossa by passing between 2 heads of

pronator teres humero-ulnar & radial heads of flexor digitorum superficialis

o Enters the palm of the hand through carpal tunnel

deep to flexor retinaculum.

No branches in the arm other than small

twigs to the brachial artery.

3. MEDIAN NERVE

MOTOR SUPPLY IN THE FOREARM

Muscles of superficial and intermediate layers of forearm flexors

except flexor carpi ulnaris Deep muscles of anterior forearm muscles except medial [ulnar] half of flexor digitorum profundus; ring and little fingers

via anterior interosseous nerve

3. MEDIAN NERVE

3 Thenar muscles

Flexor pollicis brevis Abductor pollicis brevis Opponens pollicis

2 Lateral lumbrical

muscles

MOTOR SUPPLY IN THE HAND

3. MEDIAN NERVE

SENSORY SUPPLY IN THE HAND

Skin on the palmar surfaces of lateral 3 ½ digits Cutaneous regions over dorsal aspects of distal phalanges (nail beds) of the same digits digital nerves supply the lateral two lumbrical muscles.

3. MEDIAN NERVE

1) Articular branches to the elbow joint 2) Muscular branches pronator teres , flexor carpi radialis, palmaris longus, and flexor

digitorum superficialis 3) Anterior interosseous nerve muscles in the deep layer

flexor pollicis longus, the lateral half of flexor digitorum profundus,

and pronator quadratus 4) Palmar cutaneous branch skin over the base and central palm spared in carpal tunnel syndrome passes into the hand superficial to the flexor retinaculum of the wrist

BRANCHES IN THE FOREARM

3. MEDIAN NERVE

BRANCHES IN THE HAND

Palmar digital branches

three thenar muscles

Skin on the palmar surfaces of the lateral 3 ½ digits Cutaneous regions over the dorsal aspects of the distal phalanges (nail beds) of the same digits

4. ULNAR NERVE

Enters the anterior compartment of the forearm by passing posteriorly around the medial epicondyle of the humerus between humeral & ulnar heads of flexor carpi ulnaris muscle

4. ULNAR NERVE

Flexor carpi ulnaris Medial part (Ring & little fingers) of the flexor digitorum profundus

Only 1 ½ muscles

4. ULNAR NERVE

1) Hypothenar muscles 2) Medial two lumbricals 3) Adductor pollicis 4) Deep head of the flexor pollicis brevis 5) All the interossei

MOTOR SUPPLY IN THE HAND

4. ULNAR NERVE

Medial side of the palm palmar branch of the ulnar nerve

Posteromedial side of the

back of the hand

Most skin on the posterior surfaces of medial 1 ½ digits

dorsal branch of the ulnar nerve

SENSORY SUPPLY IN THE HAND

4. ULNAR NERVE

Muscular branches flexor carpi ulnaris & medial half of flexor digitorum profundus

Two small cutaneous branches palmar branch dorsal branch

4. ULNAR NERVE

BRANCHES IN THE HAND

palmar cutaneous branch skin on the medial side of the palm dorsal cutaneous branch medial half of the dorsum of the hand, 5th finger, medial half of the 4th finger superficial branch of the ulnar nerve anterior surfaces of medial 1 ½ digits

5. RADIAL NERVE

motor and sensory functions in both the arm and the forearm only sensory functions in the hand

superficial branch (sensory or cutaneous) deep radial/posterior interosseous nerve (motor)

anterior to lateral epicondyle of the humerus

between brachialis & brachioradialis

in the lateral border of the cubital fossa

5. RADIAL NERVE

Deep branch passes between 2 heads of supinator extensor carpi radialis brevis supinator Posterior interosseous nerve after passing through two heads of supinator remaining muscles in the posterior compartment

nerve of the posterior compartment of the forearm

5. RADIAL NERVE

Passes down the anterolateral aspect of the forearm

deep to brachioradialis Enters the hand by passing over anatomical snuffbox skin over the dorsolateral aspect of the palm dorsal aspects of the lateral 3 ½ digits distally

to approximately the terminal interphalangeal joints

Superficial branch of the radial nerve

6. OTHER NERVES NERVES ARISING FROM THE

ROOTS OF THE BRACHIAL PLEXUS

Dorsal scapular nerve (Anterior ramus of C5)

levator scapulae, rhomboid major & minor Long thoracic nerve (Anterior rami of C5+C6+C7) serratus anterior

NERVES ARISING FROM THE

TRUNKS OF THE BRACHIAL PLEXUS

6. OTHER NERVES

Suprascapular nerve (C5+C6) Superior trunk

supraspinatus and infraspinatus Nerve to subclavius muscle (C5+C6) Superior trunk

subclavius

Lateral pectoral nerve pectoralis major Lateral root of median nerve

6. OTHER NERVES OTHER NERVES OF THE

LATERAL CORD OF THE BRACHIAL PLEXUS

Medial pectoral nerve pectoralis major and pectoralis minor.

Medial cutaneous nerve of arm (medial brachial cutaneous nerve) Medial cutaneous nerve of forearm (medial antebrachial cutaneous nerve)

6. OTHER NERVES OTHER NERVES OF THE

MEDIAL CORD OF THE BRACHIAL PLEXUS

Superior subscapular nerve subscapularis Inferior subscapular nerve teres major & subscapularis Thoracodorsal nerve latissimus dorsi

6. OTHER NERVES OTHER NERVES OF THE

POSTERIOR CORD OF THE BRACHIAL PLEXUS

1 2 3

ULNAR NERVE

@ NECK OF THE RADIUS o radial recurrent artery

o palmar carpal branch

o superficial palmar branch

o anterior ulnar recurrent artery

o posterior ulnar recurrent artery

o common interosseous artery

o dorsal carpal branch

o palmar carpal branch

Basilic vein +

venae comitantes of the brachial artery

Axillary vein

Cephalic vein @ deltopectoral triangle

median cubital vein a branch of the cephalic vein

Cephalic vein drains into axillary vein.

Basilic vein forms the axillary vein.