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Anatomy

Upper Limb

Question 12 of 239

A 74 year old lady slipped on a pavement and as she fell managed to grab hold off a tree branch hanging overhead before falling to the floor. She is complaining of weakness of hand movements and loss of sensation over the medial arm. MRI imaging shows injury to the medial cord of the brachial plexus. Which of the following nerve spinal nerve levels have most likely been affected:

Answer:

The medial cord (which is a continuation of the anterior division of the inferior trunk) receives nerve fibres from the C8 and T1 spinal nerve levels. The above pattern is called Klumpke's palsy.

Brachial Plexus

Anatomy / Upper Limb / Axilla

Last Updated: 8th April 2019

By Brachial_plexus.jpg:Mattopaedia at en.wikipedia derivative work: Captain-n00dle (talk), MissMJ (Brachial_plexus.jpg) [Public domain], from Wikimedia Commons

Brachial Plexus. (Image by Mattopaedia at en.wikipedia derivative work: Captain-n00dle (talk), MissMJ (Brachial_plexus.jpg) [Public domain], from Wikimedia Commons)

ROOTS:

The brachial plexus is formed by the union of the anterior rami of spinal nerves C5 - T1.

TRUNKS:

In the inferior neck, the roots of the brachial plexus unite to form three trunks:

  • A superior trunk (from the union of the C5 and C6 roots)
  • A middle trunk (which is a continuation of the C7 root)
  • An inferior trunk (from the union of the C8 and T1 roots)

DIVISIONS:

Within the posterior triangle of the neck, the trunks divide into anterior and posterior divisions.

CORDS:

Within the axilla, the divisions reunite to form three cords (named by their relation to the axillary artery):

  • The lateral cord (from the anterior divisions of the superior and middle trunks)
  • The medial cord (a continuation of the anterior division of the inferior trunk)
  • The posterior cord (from the posterior divisions of all three trunks)

NERVES:

The cords give rise to the major branches of the brachial plexus.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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