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Anatomy

Upper Limb

Question 239 of 239

You have been asked to perform the secondary survey of a patient following a fall from a horse. She describes her neck being forcibly flexed laterally. You are concerned she may have sustained a brachial plexus injury as a result. Regarding the divisions of the brachial plexus, which of the following statements is CORRECT:

Answer:

The posterior cord is formed from the posterior divisions of all three trunks. The medial cord is a continuation of the anterior division of the inferior trunk. The inferior trunk is formed from the union of the C8 and T1 nerve roots. The lateral cord is formed from the anterior divisions of the superior and middle trunks. The superior trunk is formed from the union of the C5 and C6 nerve roots.

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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