FORMATION & RELATIONS OF BRACHIAL PLEXUS

CUTANEOUS SUPPLY\ DERMATOME OF UPPER LIMB

LEARNING OBJECTIVES

At the end of this lecture students should be able to understand:

Mention formation of brachial plexus (roots, trunk, division, and cords)

Discuss the relation of brachial plexus also in connection to clavicle (Supra,
retro, infra clavicular parts
Enumerate the branches arising the different cords
Able to draw the brachial plexus
Describe cutaneous supply of arm

BRACHIAL PLEXUS

Plexus- is a network of nerves

Brachial plexus-is a network of nerves found in

the neck and axilla

Formed by ventral rami of C5- C8 AND T1 (

there may be contributions from C4, T2)

Gives rise to nerves that supply the upper limb

FORMATION

ROOTS Ventral Rami of :

C5
C6
C7
C8
T1
TRUNKS-
UPPER
MIDDLE
LOWER
DIVISONS
ANTERIOR
POSTERIOR
CORDS
MEDIAL
LATERAL
POSTERIOR

Formation of Trunks and Divisions

C5 accepts contribution from C4 and then unites

with C6 to form the upper trunk.

C7 will continue as the middle trunk.

T1 accepts contribution From T2 and then unites

with C8 to form the lower trunk.

The trunks desend laterally above the clavicle and

bifurcate into anterior and posterior division
FORMATION OF CORDS

The anterior division of the upper trunk and

middle trunk will unite to form the lateral cord.

The anterior division of the lower trunk

continues as the medial cord.

The posterior divisions of all the trunks will

unite to form the posterior cord.

RELATIONS OF THE BRACHIAL PLEXUS

Brachial plexus lies at the posterior triangle of

the neck between the angle formed by the
clavicle and the stenocleidomastoid muscle.

Found to emerge between the scalenus anterior

and scalenus medius muscles.

It is covered by the skin, deep fascia, and

platysma muscle

It is also crossed by suprascapular nerve,

external jugular vein, and inferior belly of
Omohyoid muscle
RELATIONS OF THE BRACHIAL PLEXUS IN THE AXILLA

The cords of the brachial plexus derived their names

based on their relationship with the 2nd part of the
axillary artery

The lateral cord and posterior cord lie

laterally to the 1st part of axillary artery
The medial cord lies posterior to it.
Below the pectoralis minor
the lateral cord lies lateral of the 2nd part of the
axillary artery
posterior cord lies posteriorly
The medial cord lies medially to the 2nd part of axillary artery.
Below the pectoralis minor the cords gives their terminal branches
BRANCHES OF BRACHIAL PLEXUS

BRANCHES FROM THE ROOT

1. Long thoracic nerve (C5,C6,C7).
2. Dorsal scapular nerve (C5).
3. Nerve to subclavius (C5, C6).

BRANCH FROM THE TRUNK

1. Suprascapular Nerve.

BRANCHES FROM THE LATERAL CORD

1. Lateral pectoral Nerve. ((C5, C6).
2. Musculocutaneous (C5,C6, C7)
3. Lateral root of median nerve (C5, C6, C7).

BRANCHES FROM THE MEDIAL

CORD
1. Medial pectoral nerve
2. Medial cutaneous nerve of arm
3. Medial cutaneous nerve of forearm
4. Ulnar nerve
5. Medial root of median nerve

POSTERIOR CORD BRANCHES

1. Axillary nerve (C5, C6)
2. Upper subscapular nerve (C5,C6)
3. Thoracodorsal nerve (C7,C8).
4. ower subscapular nerve (C5,C6)
5. Radial nerve (C5-T1).
.

IMPORTANT NERVES AND AREA OF SUPPLY

1) MEDIAN NERVE ( Formed by both medial and lateral cord)

A) supplies all the flexors of the forearm( except flexor carpi ulnaris and
medial half of flexor digitorum profundus)
B) intrinsic muscles in the lateral palm including thenar eminence)

2) ULNAR NERVE
Supplies the medial half of flexor digitorum profundus and the flexor carpi
ulnaris
B) supplies most of the intrinsic muscles of the hand including the
hypothenar eminence, and skin on the medial side of the hand
Clinical application
Injury to median nerve- apes hand
Injury to ulnar nerve- claw hand
3) MUSCULOCUTANEOUS NERVE
Supplies the biceps, coracobrachialis and brachialis

4) AXILLARY NERVE
- Supplies the deltoid and teres minor muscle
- Supplies the shoulder joint

5) RADIAL NERVE
- Supplies the triceps
- Supplies the brachioradialis
- Supplies most of the extensors of the forearm
- * injury results in wrist drop

Cutaneous innervations of Upper Limb

 Nerves of Brachial Plexus Supplying Upper limb

APPLIED ANATOMY OF THE BRACHIAL PLEXUS -ERBS PARALYSIS

This is the paralysis that occurs as a result of damage to the upper trunk of
the brachial plexus

a result of accidental fall or birth injury

results in damage to the nerves that

have root value of C5 and C6 which
include:
Suprascapular nerve
Nerve to subclavius
Lateral pectoral nerve
Axillary nerve
Musculocutaneous nerve

The arm is placed in an adducted position and medially rotated, the forearm
pronated and the palm facing backwards
presenting the classical waiters tip position.

ERBS PARALYSIS

1. Loss of abduction of the arm due to the damage to

the suprascapular nerve which supply the
 supraspinatus muscle and the axillary nerve which supply the deltoid
muscle.

2. The arm is medially rotated due to paralysis of the lateral rotator muscles of
the arm which include the teres minor supplied by the axillary nerve and the
infraspinatus muscle supplied by the suprascapular nerve.

3. Loss of flexion at the elbow joint due to paralysis of the biceps brachi
muscle as a result of damage to the musculocutaneous nerve.

4. Forearm is pronated due to the unopposed action of pronator teres muscle as

a result of paralysis of the biceps.

Injury to the lower roots, C8 and T1, results in

Klumpke's Palsy.

The ulnar and median nerves affected

paralysis of all of the intrinsic muscles of hand

Claw hand due to hyperextension of

metacarpophalangeal joints and flexion of digits by
forearm flexors unopposed by interossei.

Ulnar flexors of wrist and fingers are involved along

with cutaneous anaesthesia and analgesia along the
ulnar border.