Tutorial 4/2009 PAA 1015 Nerve injuries The brachial plexus is clinically very important.

It is commonly injured in newborns as a result of excessive traction of the head during forceps delivery. It is also injred whena person falls from height and tries to save himself by desperately clinging on something with his hands. Discuss the following concerning the brachial plexus. a. Draw a labelled diagram showing the formation of the different part of the brachial plexus. b. Where is the location of the different part of the brachial plexus? c. Discuss the course and distribution of the branches from the different parts of the brachial plexus. d. Briefly describe the origin, course and distribution of the long thoracic nerve. Discuss the effects of it being accidentally cut during an operation in the area. e. Briefly describe the root value, origin, course and distribution of the axillary nerve. How can it get injured and what would be the effects? How would you test its integrity in a patient? f. Briefly describe the root value, origin, course and distribution of the musculocutaneous nerve. Discuss the functional loss that would occur if it is cut by slash wound in the arm. g. A C5-6 root-lesion of the brachial plexus is not an uncommon occurance. Discuss how this sort of lesion can occur. What would be the effects in terms of cutaneous loss, muscle paralysis and deformity? h. One nerve found in the same vicinity but not part of the brachial plexus is the spinal part of the accessory nerve. Discuss the functional loss if the spinal part of the accessory nerve is accidentally cut during an operation in the neck. The nerves of the upper limbs are braches of the brachial plexus. They include the axillary, the musculocutaneous, the median, the radial and the ulnar nerves. The nerves usually supply muscle, the skin or joint. Injury to a nerve will affect the structures that that nerve supplies. a. Discuss the following concerning the ulnar nerve: i. Its root value and origin. ii. Its course, relations and distribution in the forearm. iii. Its course, relations and distribution in the hand. iv. The effects if it is injured at the wrist. v. The effects if it is injured by the fracture of the medial epicondyle of the humerus.

b. Discuss the following concerning the median nerve: vi. Its root value and origin. vii. Its course, relations and distribution in the forearm. viii. Its course, relations and distribution in the hand. ix. The effects if it is injured at the wrist. x. The effects if it is injured by a supracondylar fracture of the humerus. c. Discuss the following concerning the radial nerve: xi. Its root value and origin. xii. Its course, relations and distribution in the forearm. xiii. Its course, relations and distribution in the hand. xiv. The effects if it is injured in the radial groove because of the fracture of the shaft of the humerus. xv. What could damage it in the axilla and what would be the effects? d. What can cause a lower brachial plexus lesion (Klumpke plasy)? Discuss the extent of the functional loss when this occurs and the anatomical basis for the deformity that results.