NAME: MAHAM TALAT
ROLL NO: 12
DPT 7TH SEMESTER
DATE: 9TH MAY 2023
SUBMITTED TO: DR AMBER
TOPIC: PATTERN OF MUSCLE WEAKNESS AND FUNCTIONAL
LOSS WITH PERIPHERAL NERVE INJURIES IN UPPER
EXTREMITY
THREE NERVES FROM THE UPPER EXTREMITY:
1. AXILLARY NERVE
2. MUSCULOCUTANEOUS NERVE
3. RADIAL NERVE
PATHWAYS OF THESE NERVES:
AXILLARY NERVE:
The axillary nerve branches from the posterior cord (C5 - T1) and descends in the axilla poste-
rior to the axillary artery and anterior to the subscapularis. It emerges from the axilla at the
level of the lower border of the subscapularis, by traversing the quadrangular space. This is a
space in the posterior scapular region, which is bounded by the superior margin of the teres ma-
jor inferiorly, the inferior margin of the teres minor superiorly, the lateral margin of the long
head of the triceps brachii medially and the surgical neck of the humerus laterally. Here, it sup-
plies a branch to the shoulder joint.
The axillary nerve then passes medial to the surgical neck of the humerus before dividing into
three terminal branches:
· The anterior branch
· The posterior branch
· The articular branch
The anterior branch winds around the surgical neck of the humerus, posteriorly, with the poste-
rior circumflex humeral vessels and supplies the anterior aspect of the deltoid muscle.
The posterior branch supplies the posterior aspect of the deltoid muscle as well as the teres
minor. Following this, it passes around the lower border of the deltoid and is then referred to
as the superior/upper lateral cutaneous nerve of the arm. This nerve supplies the skin over the
lower part of the deltoid and over the upper part of the long head of triceps both anteriorly
and posteriorly.
The articular branch supplies the glenohumeral joint.
MUSCULOCUTANEOUS NERVE:
The musculocutaneous nerve emerges as the terminal branch of the lateral cord of
the brachial plexus, from the C5-C7 nerve roots. The first muscle it enters is coraco-
brachialis and gives branches to this muscle before entering it. From here it runs in the flexor
compartment superficial to the brachialis but deep to the biceps brachii muscle. As it de-
scends it innervates both of these muscles.
After giving small branch to the humerus and articular branches to the elbow joint it pierces
deep fascia and emerges lateral to biceps brachii. It then continues as the lateral cutaneous
nerve of the forearm.
The musculocutaneous nerve terminates as the lateral cutaneous nerve of the forearm that
supplies the anterolateral skin of the forearm.
RADIAL NERVE:
It originates from the posterior cord of the brachial plexus along with the axillary nerve, carry-
ing fibers from ventral roots of spinal nerves C5-C8 and T1.
The radial nerve arises in the axilla, immediately posterior to the axillary artery, between
coracobrachialis and teres major muscles. It descends obliquely downwards through the pos-
terior aspect of the arm, between the bellies of medial and lateral head of triceps, through a
shallow depression on the posterior surface of the humerus (radial groove).
For the most part of its course in the arm, the nerve is accompanied by the brachial artery.
In the distal part of the arm, the radial nerve wraps around the distal humerus and courses an-
terior to the lateral condyle of humerus, where it penetrates the lateral intermuscular septum.
Upon crossing the cubital fossa, the radial nerve terminates by dividing into two terminal
branches: superficial (sensory) and deep (motor).
.
NERVES MUSCLES IT INJURIES AND MAIN
INNERVATE DEFORMITIES LOSS OF
FUNCTION
AXILLARY NERVE deltoid muscle Isolated damage to the Paralysis of the
teres minor muscle axillary nerve leads to deltoid and teres
lateral head of the mononeuropathy, minor muscles
triceps brachii mus- which is a type of neu- Weakness of arm
cle ropathy where only one abduction
nerve is involved Wasting of the
deltoid muscle
For athletes who partic- Anaesthesia or
ipate in contact sports, loss sensation of
damage to the axillary the area of the
nerve is the most com- skin posterior to
mon peripheral nerve the deltoid muscle
injury.
MUSCULOCUTANEOUS Coracobrachialis Severed musculocuta- Weakened elbow
NERVE biceps brachii neous nerve, by a stab flexion.
brachialis muscle wound or clinical con- Weakened
sequences, so that it is supination and
no longer innervating flexion at the
the structures it nor- shoulder joint.
mally does, example Loss of sensation
the elbow flexors at the lateral part
of the forearm
would also be af-
fected
RADIAL NERVE Triceps brachii Radial nerve palsy The motor pre-
Anconeus It is the most com- sentation of the
brachioradialis ex- monly injured nerve of radial nerve in-
tensor carpi radialis the arm. jury is the wrist
longus The injuries of this drop. It occurs
extensor carpi radi- nerve usually occur due due to the paraly-
alis brevis to fractures of the sis of the poste-
supinator humerus. The nerve can rior forearm mus-
extensor digitorum also be injured when it cles and their in-
extensor digiti min- is overused (eg in ability to extend
imi sports related injuries) the wrist. The
extensor carpi ul- or compressed (eg im- sensory loss will
naris proper use of crutches) depend of the
abductor pollicis anatomical loca-
longus tion of the injury.
extensor pollicis
brevis
extensor pollicis
longus
extensor indicis
