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NERVES OF UPPER LIMB & THEIR LESIONS

NERVES OF UPPER LIMB & THEIR LESIONS. DR TATHEER ZAHRA ASSISTANT PROFESSOR ANATOMY. NERVE SUPPLY OF UPPER LIMB. DERMATOMES. (FOERSTER, 1933). (GARRETT, 1948). BRACHIAL PLEXUS. SURGICAL APPROACH. TYPES OF NERVE LESIONS. BRACHIAL PLEXOPATHY.

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NERVES OF UPPER LIMB & THEIR LESIONS

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  1. NERVES OF UPPER LIMB & THEIR LESIONS DR TATHEER ZAHRA ASSISTANT PROFESSOR ANATOMY

  2. NERVE SUPPLY OF UPPER LIMB

  3. DERMATOMES (FOERSTER, 1933) (GARRETT, 1948)

  4. BRACHIAL PLEXUS

  5. SURGICAL APPROACH

  6. TYPES OF NERVE LESIONS

  7. BRACHIAL PLEXOPATHY • Can refer to involvement of the entire plexus, or parts of the plexus • Trunk lesion • Cord lesion • Distribution of weakness and numbness depends upon the part of the plexus affected

  8. PATTERN OF INJURY • Pattern of root contribution to the plexus: • Upper trunk lesion: Sensory loss in C5 & C6 • Middle trunk lesion: Sensory loss in C7 • Lower trunk lesion: Sensory loss in the combined C8 & T1 dermatomes

  9. PRINCIPLES OF LOCALIZATION • Certain sites are prone to nerve entrapments/injuries • Nerve opposing bone ~ Ulnar nerve at the elbow • Closed spaces ~ Carpal tunnel • Adjacent structures ~ Median nerve at the elbow, adjacent to the brachial artery • Order in which branches arise • Movements at specific joints • Single nerve • Elbow extension ~ Radial • Multiple nerves • Elbow flexion ~ Musculocutaneous, Median

  10. A: VARIATIONS IN BRACHIAL PLEXUS: • Prefixed brachial plexus • Post fixed brachial plexus • B: BRACHIAL PLEXUS INJURIES: • Incomplete paralysis • Complete paralysis • Erb-Duchenne palsy • Backpacker’s palsy • Klumpke paralysis • C: BRACHIAL PLEXUS BLOCK:

  11. ERB-DUCHENNE PALSY (WAITER’S TIP)

  12. BACK PACKER’S PALSY

  13. KLUMPKE PALSY

  14. Complete claw hand Affection of: 1- Most of the small muscles of the hand (T1) 2- Ulnar flexors of the flexor compartment of forearm are partially affected (C8)

  15. BRACHIAL PLEXUS BLOCK

  16. INJURY TO NERVE ROOTS & BRANCHES

  17. INJURY TO DORSAL SCAPULAR NERVE

  18. LONG THORACIC NERVE INJURY

  19. WINGING OF SCAPULA

  20. INJURY TO CORDS & TERMINAL BRANCHES

  21. THORACODORSAL NERVE INJURY

  22. INJURY TO AXILLARY NERVE

  23. Anterior Shoulder Dislocation Dislocated Head Normal Head

  24. Waisting of shoulder Winging of the Scapula Combined Axillary and Long Thoracic Nerve Injuries

  25. MUSCULOCUTANEOUS NERVE

  26. RADIAL NERVE

  27. RADIAL NERVE INJURY IN ARM

  28. WRIST DROP

  29. MEDIAN NERVE

  30. Waisted Thenar Muscles

  31. MEDIAN NERVE INJURY AT ELBOW(HAND OF BENEDICTION)

  32. PRONATOR SYNDROME

  33. MEDIAN NERVE INJURY A- Above Elbow: 1- Loss of pronation 2-Week flexion 3-Ulnar deviation 4-Inability to flex thumb 5-Inability to oppose fingers 6-Inability to flex middle digits 7-Inability to flex Index middle fingers -Sensory loss -Ape hand deformity B- Above Wrist: 1- No Loss of pronation 2- No Week flexion 3- No Ulnar deviation 4- No Inability to flex thumb 5- Inability to oppose fingers 6- No Inability to flex middle digits 7- No Inability to flex index and middle fingers -Sensory loss -Ape hand deformity Extended index and middle Adducted and extended thumb Flat thenar eminence Flexed little and ring

  34. CARPAL TUNNEL SYNDROME

  35. ULNAR NERVE

  36. (CUBITAL TUNNEL SYNDROME)

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