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200
38

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Anatomy

Upper Limb

Question 32 of 239

You are part of the trauma team caring for a 23 year old tree surgeon who has fallen approximately 7 metres from a tree. He tells you that as he fell he tried to grab a branch and his right arm was hyperextended. He now has a weakness to the hand muscles on the right side. The trauma team leader suspects a brachial plexus injury. The brachial plexus is formed by the union of which of the following spinal nerves:

Answer:

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

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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