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axilla brachial plexus

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					UPPER EXTREMITY-2

  DR VINIT K ASHOK
  ADJUNCT FACULTY
            BLOOD SUPPLY
• ARTERIAL SUPPLY
• -SUBCLAVIAN
  ARTERY(NECK)
• - AXILLARY ARTERY( UPPER
  ARM;UPTO LOWER BORDER
  OF TERES MAJOR)
• BRACHIAL ARTERY(LOWER
  PART OF ARM)
• RADIAL ARTERY( LATERAL)
• ULNAR ARTERY(
  MEDIAL),COMMON
  INTEROSSEOUS
• PALMAR ARCHES
• DIGITAL
VEINS OF UPPER LIMB
           •   SUPERFICIAL VEINS
           -   DORSAL VENOUS NETWORK
           -   CEPHALIC VEIN
           -   BASILIC VEIN
           -   AXILLARY VEIN( BASILIC+
               BRACHIAL VEIN)
           -   MEDIAN CUBITAL VEIN
           -   MEDIAN VEIN OF FOREARM
           -   DEEP VEINS
           -   NAMED ACCORDING TO
               COMPANIAN ARTERIES
           -   RADIAL VEIN
           -   ULNAR VEIN
           -   BRACHIAL VEIN
           -   AXILLARY VEIN
           SURFACE ANATOMY
•   ACROMION                      •   CUBITAL FOSSA
•   CLAVICLE                      •   MEDIAN CUBITAL VEIN- IV
•   DELTOID ( IM INJECTIONS)      •   CEPHALIC VEIN
•   HUMERUS                       •   ULNA
•   BICEPS MUSCLE                 •   RADIUS
•   BICIPTAL GROOVE               •   STYLOID PROCESS
•   BRACHILA PULSE( BLOOD         •   RADIAL ARTERY( PULSE)
    PRESSURE)                     •   ULNAR ARTERY
•   TRICEPS                       •   ANATOMICAL SNUFF BOX
•   OLECRNON PROCESS( PT OF THE   •   THENAR EMINENC
    ELBOW)                        •   HYPOTHENAR EMINENCE
•   MEDIAL /LATERAL EPICONDYLES   •   CARPAL TUNNEL
•   TRIANGLE
CUBITAL FOSSA
CUBITAL FOSSA
STYLOID PROCESS
ANATOMICAL SNUFF BOX
              AXILLA( ARMPIT)
•  PYRAMIDAL SPACE BETWEEN THE
   UPPER LATERAL CHEST AND THE
   INNERSIDE OF THE ARM
• BOUNDARIES
-APEX –( BETWEEN THE
   CLAVICLE,SCAPULA AND 1ST RIB)
-BASE-(AXILLARY FASCIA)
-ANTERIOR ( PECTORALIS MAJOR AND
   MINOR MUSCLES)
-POSTERIOR(                        • CONTENTS
   SUBSCAPULARIS,LATISSIMUS
   DORSI AND TERES MAJOR)          -AXILLARY LYMPH NODES
MEDIAL- ( FIRST 4 RIBS AND         -AXILLARY ARTERY /VEIN
   SERRATUS ANTERIOR MUSCLE)       -BRACHIAL PLEXUS
LATERAL-( BICEPETAL GROOVE OF
   THE HUMERUS)
             BRACHIAL PLEXUS
•   PLEXUS- IS A NETWORK OF
    NERVES
•   BRACHIAL PLEXUS-
•   FOUND IN THE NECK AND AXILLA
•   FORMED BY VENTRAL RAMI OF C5-
    C8 AND T1 ( THERE MAY BE
    CONTRIBUTIONS FROM C4, T2)
•   GIVES RISE TO NERVES THAT
    SUPPLY THE UPPER LIMB
                                    •   ROOTS   FORMATION OF TRUNKS
•   FORMATION
                                    •   C5
•   ROOTS- C5-C8 AND TI( VENTRAL    •   C6
                                                         UPPER
    RAMI)                                                MIDDLE
                                    •   C7
•   TRUNKS-UPPER , MIDDLE, LOWER    •   C8               LOWER
•   DIVISONS-ANTERIOR/POSTERIOR     •   T1               FORMED IN
•   CORDS-                                               THE NECK
    MEDIAL/LATERAL/POSTERIOR
       DIVISIONS AND CORDS OF
           BRACHIAL PLEXUS
•   TRUNKS           DIVISIONS           CORDS

                   PINK-         LATERAL CORD-ANTERIOR
•   UPPER TRUNK    ANTERIOR      DIVISIONS OF UPPER AND
                   DIVISION      MIDDLE TRUNK


                                 POSTERIOR CORD-
•   MIDDLE TRUNK                 POSTERIOR DIVISIONS OF ALL
                                 TRUNKS


                                 MEDIAL CORD-ANTERIOR
                                 DIVISION OF LOWER TRUNK
•   LOWER TRUNK    BLUE -        CORDS ARE NAMED
                   POSTERIOR     ACCORDING TO THEIR
                   DIVISION      RELATIVE POSITIONS TO THE
                                 AXILLARY ARTERY
BRACHIAL PLEXUS
     NERVES ARISING FROM THE
             CORDS
•    MEDIAL CORD
1.   MEDIAL CUTANEOUS NERVE OF ARM- CUTANEOUS
     SUPPLY TO SKIN
2.   MEDIAL CUTANEOUS NERVE OF FOREARM-CUTANEOUS
     SUPPLY TO THE SKIN
3.   MEDIAL ROOT OF MEDIAL NERVE- JOINS WITH LATERAL
     ROOT TO FORM MEDIAN NERVE
4.   ULNAR NERVE
5.   MEDIAL PECTORAL NERVE
•    LATERAL CORD
1.   LATERAL ROOT OF MEDIAN NERVE
2.   MUSCULOCUTANEOUS NERVE
3.   LATERAL PECTORAL NERVE
NERVES FROM THE POSTERIOR
          CORD
•   1. UPPER SUBSCAPULAR NERVE
•   2.LOWER SUBSCAPULAR NERVE
•   3.THORACODORSAL NERVE
•   4. RADIAL NERVE
•   5. AXILLARY NERVE
IMPORTANT NERVES AND AREA
        OF SUPPLY
•   1. MEDIAN NERVE( FORMED FROM BOTH MEDIAL AND LATERAL
    CORD)-
•   A) SUPPLIES ALL THE FLEXORS OF THE FOREARM( EXCEPT FLEXOR
    CARPI ULNARIS AND MEDIAL HALF OF FDP)
•   B) INTRINSIC MUSCLES IN THE LATERAL PALM INCLUDING THENAR
    EMINENCE)
•   2. ULNAR NERVE
•   A) SUPPLIES THE MEDIAL HALF OF FDP AND THE FLEXOR CARPI
    ULNARIS
•   B) SUPPLIES MOST OF THE INTRINSIC MUSCLES OF THE HAND
    INCLUDING THE HYPOTHENAR EMINENCE, AND SKIN ON THE
    MEDIAL SIDE OF THE HAND
•   CLINICAL APPLICATION
•   *INJURY TO MEDIAN NERVE-” APE HAND”
•   INJURY TO ULNAR NERVE-” CLAW HAND”
INPORTANT NERVES AND THEIR
      AREA OF SUPPLY
•    MUSCULOCUTANEOUS NERVE
A)   SUPPLIES THE BICEPS, CORACOBRACHIALIS AND BRACHIALIS



AXILLARY NERVE
-    SUPPLIES THE DELTOID AND TERES MINOR MUSCLE
-    SUPPLIES THE SHOULDER JOINT
RADIAL NERVE
-    SUPPLIES THE TRICEPS
-    SUPPLIES THE BRACHIORADIALIS
-    SUPPLIES MOST OF THE EXTENSORS OF THE FOREARM
-    * INJURY RESULTS IN “ WRIST DROP”
            CARPAL TUNNEL
• TUNNEL FORMED BETWEEN THE CONCAVITY OF THE CARPAL
  BONES AND A LIGAMENT THAT COVERS THIS( FLEXOR
  RETINACULAM)
• TENDONS OF THE FLEXORS PASS THROUGH
• MEDIAN NERVE ALSO PASSES THROUGH
• CROWDED TUNNEL
CARPAL TUNNEL SYNDROME
- CAUSED DUE TO COMPRESSION OF THE NERVE IN THE TUNNEL
- CAUSES-
- 1. SWELLING OF THE TEDONS( OVERUSE)
- 2. PREGNANCY( EDEMA)
- 3. ARTHRITIS
SYMPTOMS- TINGLING OR NUMBNESS-LATERAL PART OF HAND,
  WEAKNESS IN THUMB MOVEMENT
TREATMENT- REST, SPLINTING,ANTI-INFLAMMATORY DRUGS,
  SURGERY
CUBITAL FOSSA
      •   TRIANGULAR DEPRESSION ON
          THE ANTERIOR ASPECT OF
          ELBOW
      BOUNDARIES
      -BASE- LINE DRAWN BETWEEN THE
          EPICONDYLES OF THE
          HUMERUS
      LATERAL BOUNDARY-
          BRACHIORADIALIS
      MEDIAL BOUNDARY- PRONATOR
          TERES
      APEX- WHERE THE MEDIAL AND
          LATREAL BOUNDARY MEET
      CONTENTS
      1.  MEDIAL CUBITAL VEIN
      2.  BRACHIAL ARTERY
      3.  TENDON OF THE BICEPS
CUTANEOUS INNERVATION
OF HAND( ANTERIORLY)
LATREAL 31/2 FINGERS
AND LATERAL PALM –
MEDIAN NERVE

MEDIAL 11/2 FINGERS AND
MEDIAL PALM- ULNAR
NERVE
CUTANEOUS NERVE SUPPLY HAND (
POSTERIORLY)
MEDIAL 11/2 FINGERS AND HAND- ULNAR
NERVE
TIPS OF FINGERS LATERAL 31/2
FINGERS- MEDIAN NERVE


REST OF LATERAL 31/2 FINGERS AND
HAND - RADIAL NERVE

				
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posted:7/31/2012
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