This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit. The brachial plexus is an arrangement of nerve fibres, running from the spine, formed by the ventral rami of the lower cervical and upper thoracic nerve roots it includes from above the fifth cervical vertebra to underneath the first thoracic vertebrac5t1. Rosemont, il, american academy of orthopaedic surgeons, 2003. It supplies afferent and efferent nerve fibers to the chest, shoulder, arm, forearm, and hand. The brachial plexus extends from the neck into the axilla. There is a significant predilection in male gender and ages between 15 and 25.
Abzug, md investigation performed at the university of maryland school of medicine, baltimore, maryland. Netters concise atlas of orthopaedic anatomy uotbih. Brachial plexus contouring with ct and mr imaging in. The brachial plexus should be composed of the anterior branch, because the upper extremity emerges in the ventral side of the body trunk. The plexus connects these five nerves with the nerves that provide sensation to the skin and permit movement in the muscles of the arm and hand.
In contrast, klumpkes, or klumpkedejerine palsy, affects the lower roots of the brachial plexus c8, t1. The brachial plexus is formed by the ventral rami of the spinal nerves c5t1. Brachial plexus, its formation, branches and clinical anatomy including concised notes. Brachial plexus definition of brachial plexus by medical. This is the feature that gave us the opportunity to image the brachial plexus anatomy. The brachial plexus is a major neural structure that provides sensory and motor innervation to the upper extremity.
Pdf the incidence of brachial plexus injuries is rapidly growing due to the increasing number of highspeed motorvehicle accidents. The brachial plexus is formed by the anterior rami of c5 through t1 option b is the correct answer 4, 5. To assess the brachial plexus by localizing the lesion at the correct level, as well as the severity of the injury requires knowledge of the anatomy. It has a supraclavicular part and an infraclavicular part that give off many of the principal nerves of the shoulder and upper limb. Ten healthy male and female white new zealand rabbits were dissected in this study. The brachial plexus is composed of ventral rami of c5, c6, c7, c8, and th1.
The brachial plexus is the network of nerves that send signals from your spine to your shoulder, arm and hand. If positive usually indicates cervical radiculopathy. Erb, or erbduchenne palsy, is the name given to a typical upper brachial plexus injury involving spinal nerve roots c5 and c6. Anatomical consideration and brachial plexus anesthesia the brachial plexus is created by distributions from c5 to t1. Different injuries, such as inflammation, stretching, and wounds in the lateral cervical region of the neck or in the axilla may cause brachial plexus injuries, and the manifestations depend on the part of the plexus that is affected. Brachial plexus tumors wustl department of neurosurgery. Surgical anatomy of the supraclavicular brachial plexus. Initial anteroposterior chest radiograph of patient involved in accident with 18wheeled truck. Other brachial plexus nerve blocks used for orthopaedic surgery of the upper. It is a 15cm long spinal column to the axilla and is responsible for cutaneous and muscular innervation of the entire upper limb and pectoral girdle. Different imaging modalities can be used to study the brachial plexus, including magnetic resonance imaging mri, computed tomography ct and ultrasound us 1, however mri is the imaging modality of choice for the evaluation of the brachial plexus due to its.
Four anatomical characteristics explain the chronology, the type, and the seat of bp. These injuries can result from a variety of etiologies, including penetrating injuries, falls, and motor vehicle trauma. There is a brachial plexus on each side of the body. It is formed from the ventral rami of the 5th to 8th cervical nerves and the ascending part of the ventral ramus of the 1st thoracic nerve. It proceeds through the neck, the axilla and into the arm. If there is compression on one or more of these nerves as a result of tos, referral of sensory. Susan mackinnon, andrew yee, university of washington school of medicine, st louis, mo, usa. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments c5c8 and t1, but variations are not uncommon. Orthopaedic examination, evaluation and intervention. The brachial plexus has 5 roots, c5, c6 join together and form the upper trunk,c7 makes the middle trunk.
Anatomy the brachial plexus is formed from five nerves that originate in the spinal cord at the neck. Brachial plexus tension test special orthopedic testing. Core lab contouring atlases brachial plexus contouring atlas. The trunks can be found within the posterior triangle of the neck, between the anterior and middle scalene muscles. Brachial plexus birth palsy bpbp is defined as an injury to any nerve root of the brachial plexus during difficult delivery. A thorough knowledge of anatomy and its impact on the two techniques is important for. This collection of nerves separates into several divisions in the region of the upper neck, giving off braches that form the. The brachial plexus is a collection of nerves that extends from the spinal cord and provides information about upper extremity function to and from the brain. Because the ulnar nerve crosses the elbow joint posteriorly, flexion of the elbow joint stretches it. Brachial plexus anatomy explained everything you need to. Us can be used for the assessment of the brachial plexus in case of trauma, tumours. Us can be considered as an alternative to magnetic resonance imaging mri in all clinical settings in which mri is contraindicated, not readily available or in case of claustrophobia. Pdf regional anesthesia of the upper extremity has several clinical.
The consideration of the development of the sharks fin makes it easier to understand why anterior branches at the several segmental levels complicatedly form a plexus fig. Brachial plexus stretch test orthopaedic examination of. Like the epidural space, this space limits the spread of the local anesthetic and conducts it. Brachial plexus introduction and anatomy springerlink. Procedure patient seated or supine examiner passively elevates straight arm, then externally rotates arms and holds in position just before onset of symptoms examiner then laterally flexes head and extends wrist. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. The three principle bptts assess the median, radial, and ulnar nerves. Each of the five nerves in the brachial plexus has a specific function, such as powering muscles or carrying sensory information from the hand to. The brachial plexus is divided, proximally to distally into ramiroots, trunks, divisions, cords, and terminal branches. Branches from the 4th cervical and the 2nd thoracic ventral ramus may contribute. The full text of this article is available in pdf format. All of the blocks of the brachial plexus are based on the concept that the nerve plexus lies within a perivascular and perineural space in its course from the transverse processes to the axilla. The brachial plexus is a complex anatomical network of nerves that mainly supplies the upper limb. Journal of brachial plexus and peripheral nerve injury.
Blockade of the brachial plexus can provide surgical anesthesia of the hands, upperlower arm, and shoulder depending on the approach. The brachial plexus passes from the neck to the axilla and supplies the upper limb. These form 3 trunks that separate into 6 divisions then form cords that give rise to nerves. However, due to the increasing participation in extreme sports and the increased number of motor vehicle accidents survivors, there is global increase in the incidence of brachial plexus injuries 914.
Brachial plexus injury doctors and departments mayo clinic. They consist of 3 branches from the roots and 3, 5 and 5 from the lateral, medial and posterior cords respectively. Both these types of lesions usually involve a specific injury mechanism that results in the excessive stretching of either the upper plexus due to an increase. Injuries to the brachial plexus affect both motor and sensory functions in the upper limb. The brachial plexus is formed by the anterior primary rami of c5 through t1 and provides sensory and motor innervation of the upper extremity.
Ebraheims educational animated video describes the anatomy of the brachial plexus. The brachial plexus is a network of nerves innervating the muscles of the shoulder, upper chest, and arm. Articles on diagnostic and imaging aspects of the peripheral nervous system are welcomed as well. The brachial plexus is not formed by just the posterior cervical sensory rootlets option a is not correct. Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions. Pdf brachial plexus blocks for upper extremity orthopaedic surgery.
Anatomy of the brachial plexus the brachial plexus is a large network of nerves. Pdf treatment options for brachial plexus injuries researchgate. The only exception to the 3, 5, 5 rule is in the branch. We also discuss radiation tolerance doses beyond which the risk for complications increases for the brachial plexus. It was found that the brachial plexus of the white new zealand rabbit was formed by ventral branches of c5, c6, c7, c8, t1 and t2 spinal nerves. Adult traumatic brachial plexus injuries atbpis are devastating lifealtering injuries that result in notable physical disability, psychological distress, and socioeconomic hardship. Brachial plexus tension test bptt for the ulnar nerve. A thorough understanding of the anatomy of this region provides the clinician with valuable. Brachial plexus anatomy, diagnosis and orthopaedic treatment. Indications brachial plexus stretch test is used to reproduce radicular pain in the arms. It is difficult to specify the exact number of patients with brachial plexus injuries per year. Journal of brachial plexus and peripheral nerve injury jbppni is an open access, online journal encompassing all aspects of basic and clinical research findings in the area of brachial plexus and peripheral nerve injury. All of the nerves for the upper extremity arise from the brachial plexus, a network of nerves that practically provides full sensory and motor innervation to the arm.
An injury involves any condition that impairs the function of the brachial plexus. The brachial plexus tension test bptt is actually a series of three tests, each one designed to assess one of the three major nerves of the brachial plexus that enter the hand. Mayo clinic has one of the largest and most experienced practices in the united states, with campuses in arizona, florida and minnesota. Elbow arthroscopy, elbow replacement, shoulder replacement, nerve reconstruction, rotator cuff surgery. Ultrasound us is a largely available, costeffective and innocuous technique to assess the brachial plexus. When the basic pattern has been learned it is a simple matter to put in the branches of the plexus. The plexus is made by merging of the anterior branches of the 5th, 6th, 7th and 8th cervical nerves c5c8 with the participation of the anterior branch of the first thoracic spinal nerve th1.