Brachial plexus

a major nerve network

supplying the upper limb which
begins in the neck and extends
into the axilla.
 FORMATION

1-Roots
. The brachial plexus is formed by
the union of the ventral rami of C5
through C8 nerves and the greater
part of the ventral ramus of Tl
(The anterior rami of the spinal
nerves of C5, 6, 7, 8, and T1 ).
 The sympathetic fibers carried by each root
of the plexus are received from the gray rami
of the middle and inferior cervical ganglia as
they pass between the scalene muscles

In the inferior part of the neck, the

roots of the brachial plexus unite to
form three trunks.
 11-THE TRUNKS

• UPPER TRUNK--from the union of the C5

and C6 roots
• MIDDLE TRUNK--a continuation of the C7
root
• LOWER TRUNK-from the union of the C8
and T1 roots.
 111-THE DIVISIONS
Each trunk of the brachial plexus divides into
anterior and posterior divisions as the plexus
passes posterior to the clavicle (through the
cervicoaxillary canal).

Anterior divisions supply anterior (flexor)

compartments of the upper limb,
and posterior divisions supply posterior
(extensor) compartments.
 1V-THE CORDS
• Anterior divisions of the upper and
middle trunks unite to form the lateral
cord
• Anterior division of the lower trunk
continues as the medial cord
• Posterior divisions of all three trunks
unite to form the posterior cord.
The cords of the brachial plexus bear
the relationship to the second part
of the axillary artery that is indicated
by their names (e.g., the lateral cord
is lateral to the axillary artery)
 V-THE BRANCHES
A-FROM THE ROOTS
1- The dorsal scapular nerve arises from the C5
root and passes through the scalenus medius
muscle to supply the rhomboideus and levator
scapulae muscles
2-The long thoracic nerve to the serratus anterior
arises from the C5, 6, and 7 roots and also pierces
the scalenus medius muscle as it passes posterior
to the plexus.
 B-FROM THE TRUNKS

ONLY TWO BRANCHES FROM UPPER TRUNK

1- The nerve to the subclavius:It descends
posterior to the clavicle and anterior to the
brachial plexus to supply the subclavius.
2- The suprascapular nerve: It supplies the
supraspinatus and in- infraspinatus and the
shoulder joint
 C- FROM THE CORDS
MEDIAL CORD
1. MEDIAL CUTANEOUS NERVE OF ARM- (CUTANEOUS SUPPLY
TO SKIN)
2. MEDIAL CUTANEOUS NERVE OF FOREARM-(CUTANEOUS
SUPPLY TO THE SKIN)
3. MEDIAL ROOT OF MEDIAN NERVE- JOINS WITH LATERAL
ROOT (FROM LATERAL CORD)TO FORM MEDIAN NERVE
4. ULNAR NERVE
5. MEDIAL PECTORAL NERVE
LATERAL CORD
1. LATERAL ROOT OF MEDIAN NERVE
2. MUSCULOCUTANEOUS NERVE
3. LATERAL PECTORAL NERVE
NERVES FROM THE POSTERIOR
CORD
1. UPPER SUBSCAPULAR NERVE
2.LOWER SUBSCAPULAR NERVE
3.THORACODORSAL NERVE
4. RADIAL NERVE
5. AXILLARY NERVE
Brachial Plexus
 Erb’s palsy
• Upper trunk or Erb’s palsy in newborn is due
to trauma during a forceps delivery, during
which there may be forceful separation of
neck and shoulder with stretching of the
upper trunk.
• May occur due to accidental trauma
 Erb’s point
• Meeting point of 6
nerves
– Ventral rami of C5 and
C6, suprascapular
nerve and nerve to
subclavius branches of
the upper trunk and
anterior and posterior
divisions of the upper
trunk
 Erb’s point
• The deformity is
Policeman’s tip hand,
in which the arm is
adducted and
medially rotated the
forearm is extended
and pronated.
 Policeman’s tip hand

Position Paralysis of Over action of

Supraspinatus & Adductors of

Adduction of arm
Deltoid shoulder joint
Medial rotation of Teres minor and Medial rotators of
arm infraspinatus shoulder
Biceps brachii,
Extension of fore Extensors of
Brachialis &
arm elbow
Brachioradialis
Pronation of Biceps brachii & Pranators of
forearm Supinator forearm
 Trace the course of nerves through the neck noting especially: the sensory and motor
branches of the cervical and brachial plexuses, their course and distribution in the neck and
their relationship to major bony, muscular, or vascular landmarks in the region.
Great auricular n.
Hypoglossal n. (XII) C1
Great auricular n. Lesser occipital n.
Lesser
occipital
C2 n.
Transverse
cervical
nn.
C3

C4
Ansa cervicalis
Accessory n. (XI)

Hypoglossal n. (XII) C5
Supraclavicular nn.
Accessory n. (XI)
Phrenic n.
Ansa cervicalis
C5
Dorsal scapular n.
C6 Nn. to longus colli and scalenes

Vagus n. (X) C7 Suprascapular n.

C8
Phrenic n.

T1

Long thoracic n.
Trace the course of nerves through the neck noting especially: the extension of
the upper part of the sympathetic trunk into the neck region.

Vagus (X)
C1
Sup. Cervical gang.

C2
C3
Carotid plexus
C4 Glossopharyngeal (IX)
Middle C5
Cervical gang.
C6
C7
Cervicothoracic
gang. C8