Download MBBS Anatomy PPT 7 Brachial Plexus Notes

Objectives

Spinal Nerves
Nerve Plexus

--- Content provided by FirstRanker.com ---

BP ? Origin & Relations
Formation
Parts of BP
Distribution - Nerve Supply ? areas
Anatomical Variations

--- Content provided by FirstRanker.com ---

Applied Anatomy

Dr.Ravi 2/1/2022

2

--- Content provided by FirstRanker.com ---

Spinal Nerves

Spinal nerves attach to the

--- Content provided by FirstRanker.com ---

spinal cord via roots

Dorsal root

Has only sensory neurons

--- Content provided by FirstRanker.com ---

Attached to cord via rootlets
Dorsal root ganglion

Ventral root

--- Content provided by FirstRanker.com ---

Has only motor neurons
No ganglion - all cel bodies

of motor neurons found in

--- Content provided by FirstRanker.com ---

gray matter of spinal cord

Dr.Ravi 2/1/2022

3

--- Content provided by FirstRanker.com ---

Spinal Nerves

31 pair

--- Content provided by FirstRanker.com ---

each contains thousands of nerve fibers
Al are mixed nerves have both sensory and motor

neurons

--- Content provided by FirstRanker.com ---

Connect to the spinal cord

Exit from SC ? Supplying the muscles & structures

of the body

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

4

--- Content provided by FirstRanker.com ---

Spinal Nerves

8 pairs of cervical nerves from

C1 to C8

--- Content provided by FirstRanker.com ---

12 pairs of thoracic nerves

from T1-T12

--- Content provided by FirstRanker.com ---

5 pairs of lumbar nerves from

L1 to L5

5 pairs of sacral nerves from

--- Content provided by FirstRanker.com ---

S1 to S5

1 pair of coccygeal nerves

--- Content provided by FirstRanker.com ---

located at C zero (Co)

Dr.Ravi 2/1/2022

5

--- Content provided by FirstRanker.com ---

Formation of Rami

Rami are lateral branches of a

spinal nerve

--- Content provided by FirstRanker.com ---

Rami contain both sensory and

motor neurons

--- Content provided by FirstRanker.com ---

Two major groups

Dorsal ramus

Neurons innervate the

--- Content provided by FirstRanker.com ---

dorsal regions of the

body

--- Content provided by FirstRanker.com ---

Ventral ramus

Larger
Neurons innervate the

--- Content provided by FirstRanker.com ---

ventral regions of the

body

Braid together to form

--- Content provided by FirstRanker.com ---

plexuses (plexi)

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

6

Nerve Plexuses

Nerve plexus

--- Content provided by FirstRanker.com ---

A nerve plexus is nothing more than a

system or network of connected nerve

--- Content provided by FirstRanker.com ---

fibers that link spinal nerves with specific

areas of the body . A network of ventral

rami.

--- Content provided by FirstRanker.com ---

Ventral rami (except T2-T12)

Branch and join with one another
Form nerve plexuses

--- Content provided by FirstRanker.com ---

In cervical, brachial, lumbar, and sacral

re

--- Content provided by FirstRanker.com ---

gio

N n

o splexus formed in thoracic region of s.c.

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

7

--- Content provided by FirstRanker.com ---

Branches

Dorsal Ramus

of

--- Content provided by FirstRanker.com ---

Neurons within muscles of trunk and back

Spinal

--- Content provided by FirstRanker.com ---

Nerves

Ventral Ramus (VR)

Braid together to form plexuses

--- Content provided by FirstRanker.com ---

Cervical plexus - VR of C1-C4
Brachial plexus - VR of C5-T1
Lumbar plexus - VR of L1-L4
Sacral plexus - VR of L4-S4

--- Content provided by FirstRanker.com ---

Coccygeal plexus -VR of S4&S5

Communicating Rami: communicate

with sympathetic chain of ganglia

--- Content provided by FirstRanker.com ---

Covered in ANS unit

12-8

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

8

Brachial Plexus - Origin

--- Content provided by FirstRanker.com ---

Formed by ventral rami of spinal

nerves C5-T1

--- Content provided by FirstRanker.com ---

Five ventral rami form

Roots / Trunks that separate into
Divisions that then form
Cords that give rise to Branches

--- Content provided by FirstRanker.com ---

Major nerves

Axil ary
Radial

--- Content provided by FirstRanker.com ---

Musculocutaneous
Ulnar
Median

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

9
Brachial Plexus

15 cms long ,spinal column to

--- Content provided by FirstRanker.com ---

axil a.

Brachial plexus is responsible for

--- Content provided by FirstRanker.com ---

cutaneous (sensory) and
muscular (motor) innervation of
the entire upper limb & pectoral
girdle.

--- Content provided by FirstRanker.com ---

It proceeds through the neck, the

axil a and into the arm.

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

10

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

11

Relations - BP

In neck- posterior triangle,

--- Content provided by FirstRanker.com ---

being covered by skin,

Platysma, & deep fascia; where

--- Content provided by FirstRanker.com ---

it is crossed by supraclavicular

nerves, inferior belly of

Omohyoid, external jugular vein,

--- Content provided by FirstRanker.com ---

& transverse cervical artery.

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

12

Relations - BP

When it emerges between

--- Content provided by FirstRanker.com ---

Scalene anterior &

medius

--- Content provided by FirstRanker.com ---

--* its upper part lies

above 3rd part of

subclavian artery,

--- Content provided by FirstRanker.com ---

* while trunk formed by

union of C8 & T1 is

--- Content provided by FirstRanker.com ---

placed behind artery.

Dr.Ravi 2/1/2022

13

--- Content provided by FirstRanker.com ---

Relations - BP

Plexus next passes behind clavicle,

Subclavius, & transverse scapular vessels, &

--- Content provided by FirstRanker.com ---

lies upon 1st digitation of Serratus anterior, &

Subscapularis.

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

14

Relations

--- Content provided by FirstRanker.com ---

In axilla it is placed

lateral to first portion of

--- Content provided by FirstRanker.com ---

axillary artery; it

surrounds 2nd part of

artery, one cord lying

--- Content provided by FirstRanker.com ---

medial to it, one lateral to

it, and one behind it; at

--- Content provided by FirstRanker.com ---

lower part of the axilla it

gives off its terminal

branches to upper limb.

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

15

--- Content provided by FirstRanker.com ---

Anatomy CORD & BRANCH DIVISION

TRUNK

ROOT

--- Content provided by FirstRanker.com ---

Dorsal scapular N.

C4

--- Content provided by FirstRanker.com ---

Suprascapular N.

C5

UT

--- Content provided by FirstRanker.com ---

Lateral pectoral

C6

--- Content provided by FirstRanker.com ---

AD

RD

N.subclavius

--- Content provided by FirstRanker.com ---

PD

AL CO

--- Content provided by FirstRanker.com ---

A

C

PDD

--- Content provided by FirstRanker.com ---

7

MT

--- Content provided by FirstRanker.com ---

LATER

PD

C8

--- Content provided by FirstRanker.com ---

PD

MUSCULO CUTANEOUS

--- Content provided by FirstRanker.com ---

D

T

L

--- Content provided by FirstRanker.com ---

AD

T

--- Content provided by FirstRanker.com ---

AL ROOT

A

1

--- Content provided by FirstRanker.com ---

XILLARY

LATER

--- Content provided by FirstRanker.com ---

N. to latissimus

RADIAL NERVE POSTERIOR COR

M

--- Content provided by FirstRanker.com ---

dorsi

T2

--- Content provided by FirstRanker.com ---

EDIAL ROOT

MEDIAL COR

U. Subscapular

--- Content provided by FirstRanker.com ---

Long thoracic

L. Subscapular

--- Content provided by FirstRanker.com ---

MCF MCA Medial pectoral

MEDIAN NERVE

ULNAR NERVE

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

16

--- Content provided by FirstRanker.com ---

Brachial Plexus Branches

Dr.Ravi 2/1/2022

17

--- Content provided by FirstRanker.com ---

Brachial Plexus Branches
Branches of the Roots

?Long thoracic nerve(C5,C6,C7)

--- Content provided by FirstRanker.com ---

?Dorsal scapular nerve(C5)

?N. to longus colli & scaleni

Branches of Trunks

--- Content provided by FirstRanker.com ---

?Suprascapular nerve(C5,C6)

?Nerve to subclavius(C5,C6)
Branches of Lateral Cord

--- Content provided by FirstRanker.com ---

?Lateral Pectoral (C5-C7)

?Musculocutaneous (C5-C7)

--- Content provided by FirstRanker.com ---

?Lateral root of Median Nerve (C5-C7)

Dr.Ravi 2/1/2022

18

--- Content provided by FirstRanker.com ---

Brachial Plexus Branches

Branches of Medial Cord

--- Content provided by FirstRanker.com ---

?Medial pectoral(C8-T1)

?Medial cutaneous nerve of arm(C8-T1)

?Medial cutaneous nerve of forearm(C8-T1)

--- Content provided by FirstRanker.com ---

?Ulnar nerve(C7,C8,T1)

?Medial root of median nerve(C8-T1)
Branches of Posterior Cord

--- Content provided by FirstRanker.com ---

?Upper subscapular (C5,C6)

?Thoracodorsal (C6-C8)

--- Content provided by FirstRanker.com ---

?Lower subscapular (C5,C6)

?Axil ary (C5,C6)

?Radial (C5-C8,T1)

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

19

--- Content provided by FirstRanker.com ---

Muscles supplied by Brachial plexus

Dr.Ravi 2/1/2022

20

--- Content provided by FirstRanker.com ---

Mode of Brachial Plexus Injuries

? Road traffic accident
? Penetrating injuries

--- Content provided by FirstRanker.com ---

? Surgical complications
? Birth Injuries
? Domestic violence and accidents

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

21


Traumatic Brachial Plexopathies

--- Content provided by FirstRanker.com ---

Penetrating injury
? Infraclavicular plexus commonly affected
? Knife, gun shot etc
? Less common incident

--- Content provided by FirstRanker.com ---

? direct contact, hematoma pseudoaneurysm

Dr.Ravi 2/1/2022

22

--- Content provided by FirstRanker.com ---

Traumatic Brachial Plexopathies

Closed traction injuries
? Supraclavicular injuries- forced

--- Content provided by FirstRanker.com ---

separation of head and shoulder

? Infraclavicular injuries- forced

--- Content provided by FirstRanker.com ---

separation of arm from the torso (hyper
abduction)

? Root avulsion- more serious
? Ventral roots are more prone to injury-

--- Content provided by FirstRanker.com ---

lesser calibers ,thinner dural sac

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

23

Tractional Brachial Plexus

Injury

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

24

--- Content provided by FirstRanker.com ---

Obstetric Brachial Plexopathies

Five pattern of injuries
C5,C6(Erb's palsy)
C5-T1 with some finger flexion sparing

--- Content provided by FirstRanker.com ---

C5-T1 with flail arm and Horner's syndrome
C5-T1 with Horner (Klumpke's palsy)

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

26

--- Content provided by FirstRanker.com ---

Plexopathies

Dr.Ravi 2/1/2022

27

--- Content provided by FirstRanker.com ---

Erb's Paralysis

? Injury of upper trunk at Erb's point, caused by traction

--- Content provided by FirstRanker.com ---

on arm at birth or due to accident

? Nerve root avulsion from cord, involved C5 & C6 causing

paralysis of deltoid, biceps, brachialis, brachioradialis &

--- Content provided by FirstRanker.com ---

supinator muscles

? Abduction, lateral rotation of arm & flexion &

supination of forearm lost

--- Content provided by FirstRanker.com ---

? Waiter's tip position (Adduction & medial rotation of

arm, extension of elbow and pronation of forearm)

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

28

?Sensory loss over

--- Content provided by FirstRanker.com ---

the arm

Waiter's tip deformity

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

29

Upper brachial plexus Erb-Duchenne palsy

--- Content provided by FirstRanker.com ---

? Results from excessive displacement of the head to the opposite side and

depression of the shoulder on the same side

--- Content provided by FirstRanker.com ---

Difficult labour

Motorcycle fal

Malposition of the upper

--- Content provided by FirstRanker.com ---

limb on the operation table

? Abrasions on the face and

--- Content provided by FirstRanker.com ---

shoulder show how this

motorcyclist pulled his entire

plexus apart

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

30

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

Upper brachial plexus Erb-Duchenne palsy

The lesion produced is similar to that produced by a stab or bul et wound in the

neck affecting the superior trunk of the brachial plexus

--- Content provided by FirstRanker.com ---

Superior trunk

Neck wound

--- Content provided by FirstRanker.com ---

? Affects C5 & C6 roots or the superior

trunk

? suprascapular nerve, nerve to subclavius,

--- Content provided by FirstRanker.com ---

musculocutaneous, and axil ary nerves

are affected

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

31

Upper brachial plexus Erb-Duchenne palsy

--- Content provided by FirstRanker.com ---

? Abduction, lateral rotation, and

flexion at the shoulder are

--- Content provided by FirstRanker.com ---

affected

? limb hangs by side adducted and

medially rotated by unopposed

--- Content provided by FirstRanker.com ---

pectoralis major

? forearm extended and pronated

--- Content provided by FirstRanker.com ---

because action of biceps is lost

? Affects C5 & C6 roots or the superior

trunk

--- Content provided by FirstRanker.com ---

? suprascapular nerve, nerve to subclavius,

musculocutaneous, and axil ary nerves

--- Content provided by FirstRanker.com ---

are affected

Waiter's tip position

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

32

Klumpke's Paralysis

--- Content provided by FirstRanker.com ---

? Injury of lower trunk
? Caused due to hyper abduction of arm (extended arm

in a breech delivery, a fal on a outstretched arm)

--- Content provided by FirstRanker.com ---

? C8,T1 & some time C7 are involved
? Intrinsic muscles of hand & flexors of wrist(C6,C7,C8)

& fingers (C8,T1) are affected

--- Content provided by FirstRanker.com ---

? Claw hand deformity & anesthesia along the ulnar

border of the forearm & hand

? Horner's syndrome (injury to sympathetic fibers to

--- Content provided by FirstRanker.com ---

head & neck)

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

33

Lower brachial

plexus

--- Content provided by FirstRanker.com ---

Klumpke palsy

results from excessive

--- Content provided by FirstRanker.com ---

? or when a person

abduction of the arm

falls from a height

--- Content provided by FirstRanker.com ---

as in during labor

grasping something

--- Content provided by FirstRanker.com ---

to save himself

? Cervical rib

Note the transverse process of C7

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

34

--- Content provided by FirstRanker.com ---

--- Content provided by FirstRanker.com ---

Lower brachial plexus Klumpke palsy

Affects C8&T1

Claw hand

--- Content provided by FirstRanker.com ---

? Small muscles of the hand are

affected

--- Content provided by FirstRanker.com ---

Note wasting of dorsal interossei

Dr.Ravi 2/1/2022

35

--- Content provided by FirstRanker.com ---

Klumpke's Paralysis

Horner's syndrome

--- Content provided by FirstRanker.com ---

Ptosis, myosis,enophthalmos and

loss of ciliospinal reflex

Claw hand deformity

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

36

--- Content provided by FirstRanker.com ---

Supraclavicular Brachial Plexopathies

Burner syndrome (stinger syndrome)
? Forceful separation of head & shoulder ( lateral neck

--- Content provided by FirstRanker.com ---

extension & shoulder depression after a blunt force to
head & neck)

? Presented with unilateral sharp burning pain in neck

--- Content provided by FirstRanker.com ---

radiating to arm

? Classical C6 distribution,C5 may also affected
? Male sports person
? Permanent neurological dysfunction is rare

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

37

--- Content provided by FirstRanker.com ---

Burner syndrome (Stinger syndrome)

Dr.Ravi 2/1/2022

38

--- Content provided by FirstRanker.com ---

Winging of Scapula

--- Content provided by FirstRanker.com ---

? Serratus anterior stabilizes the

scapula

--- Content provided by FirstRanker.com ---

? Winging occurs due to

weakness in serratus anterior

? Injury to the nerve to serratus

--- Content provided by FirstRanker.com ---

anterior ( long thoracic nerve)

? Injury occurs during surgery or

--- Content provided by FirstRanker.com ---

due to infection

? Pushing and/or punching

defect

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

39

--- Content provided by FirstRanker.com ---

Winging scapula:

?Injury to the long thoracic nerve

?Resulting from the blows on the

--- Content provided by FirstRanker.com ---

posterior triangle of the neck

?Serratus anterior muscle paralysed

--- Content provided by FirstRanker.com ---

?Inability to protract & rotate the scapula

during the abduction of the arm above the

head

--- Content provided by FirstRanker.com ---

?Medial border and inferior angle of the

scapula elevated

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

40

Supraclavicular Brachial Plexopathies

--- Content provided by FirstRanker.com ---

Rucksack palsy ( cadet palsy, pack

palsy)

--- Content provided by FirstRanker.com ---

? Classical presentation ?pain

weakness associated with wearing a
backpack

--- Content provided by FirstRanker.com ---

? Sensory involvement and most are

due to demyelinating conduction
block (neuropraxia) of brachial plexus

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

41

Cervical rib

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

42

--- Content provided by FirstRanker.com ---

True neurogenic thoracic outlet

--- Content provided by FirstRanker.com ---

syndrome

Dr.Ravi 2/1/2022

43

--- Content provided by FirstRanker.com ---

Thoracic outlet syndrome

? Compression of subclavian artery

--- Content provided by FirstRanker.com ---

and lower trunk of brachial
plexus in the area of the clavicle.

? This can happen when there is an

--- Content provided by FirstRanker.com ---

extra cervical rib

? There may be pain in neck &

shoulders, & numbess in the last 3

--- Content provided by FirstRanker.com ---

fingers & inner forearm.

? radial pulse may be easily

obliterated by movements of the

--- Content provided by FirstRanker.com ---

arm, particularly with arm
extended & abducted at shoulder.

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

44

True neurogenic thoracic outlet syndrome

? Brachial plexus fibers compromised

--- Content provided by FirstRanker.com ---

by a translucent band extending
from rudimentary cervical rib to 1st
rib

--- Content provided by FirstRanker.com ---

? C8 and T1 fibers are mostly affected
? Presented with pain, paresthesia in

the neck shoulder and along the
medial border of hand

--- Content provided by FirstRanker.com ---

? Weakness of the muscles in the

hand

--- Content provided by FirstRanker.com ---

? symptom & sign of vascular

compromise

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

45

True neurogenic thoracic outlet syndrome

--- Content provided by FirstRanker.com ---

Adson's Maneuver Allen's Test
Management-Surgical lysis of fibrous band or resection of

cervical rib

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

46

--- Content provided by FirstRanker.com ---

Supraclavicular Brachial Plexopathies

Pancoast Syndrome
? Superior lobe carcinoma of

--- Content provided by FirstRanker.com ---

lung, mainly NSCC

? Compression of T1 as only

pleura separates lung from

--- Content provided by FirstRanker.com ---

T1

? Shoulder pain radiating in an

ulnar distribution down the

--- Content provided by FirstRanker.com ---

arm

Pancost tumor MRI

? Shoulder pain worse at night

--- Content provided by FirstRanker.com ---

? Associated with Horner

syndrome

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

47

Pancoast Tumor

--- Content provided by FirstRanker.com ---

CT Chest- Pancoast Tumor Invading T1

Dr.Ravi 2/1/2022

48

--- Content provided by FirstRanker.com ---

Infraclavicular Brachial Plexopathies

? Crutch palsy: radial nerve compression

--- Content provided by FirstRanker.com ---

? Midshaft clavicular fracture: medial cord

injury

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

49

Nonspecific Brachial Plexopathies

--- Content provided by FirstRanker.com ---

Neuralgic Amyotrophy
? Frequently involves long thoracic, axil ary and

supraclavicular nerves

--- Content provided by FirstRanker.com ---

? Presenting feature: abrupt shoulder or upper

arm pain, often nocturnal onset

? Pain abates after 7-10 days

--- Content provided by FirstRanker.com ---

? 50% associated with infection

Dr.Ravi 2/1/2022

50

--- Content provided by FirstRanker.com ---

1. The middle trunk of the brachial plexus is

formed by anterior rami of which spinal

cord segments?

--- Content provided by FirstRanker.com ---

a. C7
b. C6 and C7
c. C6
d. C5 and C6
e. C7 and T1

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

51

--- Content provided by FirstRanker.com ---

2. Postoperative examination revealed that the

medial border and inferior angle of the left

scapula became unusually prominent

--- Content provided by FirstRanker.com ---

(projected posteriorly) when the arm was

carried forward in the sagittal plane,

--- Content provided by FirstRanker.com ---

especially if the patient pushed with

outstretched arm against heavy resistance

(e.g., a wall). What muscle must have been

--- Content provided by FirstRanker.com ---

denervated during the axil ary dissection?

A. Levator scapulae

--- Content provided by FirstRanker.com ---

b. Pectoralis major

c. Rhomboideus major

d. Serratus anterior

--- Content provided by FirstRanker.com ---

e. Subscapularis

Dr.Ravi 2/1/2022

--- Content provided by FirstRanker.com ---

52

3. A person sustains a left brachial plexus injury in an auto accident.

After initial recovery the following is observed:

--- Content provided by FirstRanker.com ---

1) the diaphragm functions normally,

2) there is no winging of the scapula,

--- Content provided by FirstRanker.com ---

3) abduction cannot be initiated, but if the arm is helped through

first 45 degrees of abduction, patient can fully abduct arm.

From this amount of information and your knowledge of

--- Content provided by FirstRanker.com ---

formation of the brachial plexus where would you expect

injury to be:

--- Content provided by FirstRanker.com ---

a. Axil ary nerve

b. Posterior cord

c. Roots of plexus

--- Content provided by FirstRanker.com ---

d. Superior trunk

e. Suprascapular nerve

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

53

4. In a case of Erb's palsy, where roots C5

--- Content provided by FirstRanker.com ---

and C6 of the brachial plexus are avulsed

(torn out) which muscle is paralyzed?

--- Content provided by FirstRanker.com ---

A. Latissimus dorsi

b. Pectoralis minor

c. Supraspinatus

--- Content provided by FirstRanker.com ---

d. Trapezius

e. Triceps brachii

--- Content provided by FirstRanker.com ---

Dr.Ravi 2/1/2022

54