THE BRANCHIAL PLEXUS

 Defination :
A network of nerves formed by the union of anterior rami of lower cervical and
upper thoracic spinal nerve is called as branchial plexus.
 Formation :-
Anterior rami of C5, C6, C7, C8 and T1
 Division of Branchial Plexus :-
It is divided into ------------
a) Roots
b) Trunks
c) Divisions
d) Cords
e) Branches
 Location :-
The roots, trunks, divisions of plexus lie in posterior triangle of neck and cords
lie in axial.
 Variation :-
Origin of plexus may be prefixed plexus and post fixed plexus.
Variation

Prefixed Plexus Post fixed Plexus

- May shift one segment upwards - May shift one
segment down wards.
- (C4, C5, C6, C7, C8) (C6, C7, C8, T1, T2)
 Structure :
a) From roots of nerves in posterior triangle of neck trunk is form.
 b) The trunk formed as follows-
i) Roots of C5 and C6 form ----------upper trunk
ii) roots of C7 form --------- Middle trunk
iii) Roots of C8 and T1 form --------lower trunk

c) Division :
Division of branchial plexus are formed by each trunk dividing into
Anterior (ventral) and posterior (Dorsal) which supply to anterior and
posterior aspect of limbs.
d) Cords :
The division join to form cords. Which lie in maxilla.
i) Lateral cord is formed by --------ventral division of upper and
middle trunk.
ii) Medial cord is formed by --------- ventral division of lower trunk.
iii) Posterior cord is formed by -------- Dorsal division of all 3 trunks
i.e. upper, middle lower trunks.
 Branches of the branchial plexus of upper limb :
1) Branches of root :
- Dorsal scapular nerve (c5)
- Nerve to serratus anterior (C5, C6, C7)
2) Branches of upper trunk :
- Suprascapular nerve ( C5, C6)
- Nerve to subclavian ( C5, C6)
3) Branches from cord :
a) Branches of lateral cord ( C5, C6, C7)
- Lateral pectoral nerve
- Musculo cutaneous nerve
 - Lateral root of median nerve
b) Branches of medial cord.
- Medial pectoral nerve
- Medial cutaneous nerve of arm.
- Medial cutaneous nerve of forarm
- Medial root of median nerve
- Ulnar nerve.
4) Branches of posterior cord :
- Upper subscapular nerve ( c5, C6)
- Lower subscapular nerve ( C5, C6)
- Axillary nerve ( C5, C6)
- Nerve to latisimus dorsi ( C5, C7, C8)
- Radial nerve ( C5, C6, C7, C8, T1)
 Applied Anatomy :
Injury to brachial plexus
1) Erb’s paralysis : The upper trunk is called as Erb’s appoint and injury to this
trunk is called as Erb’s paralysis
2) Cause of injury
Undue separation of head from shoulder which is seen in
a) Borth injury
b) Fall on shoulder
c) During anesthesia
3) Nerve root involved C5, C6
4) Musde paralyse…
Biceps, deltoid, branchialis, brachioradialis, supraspinatus
Infraspinatus
 5) De formity : the arm hangs by side it is adducted and medialy rotated. The
for
arm axtended and pronated and deformati is called as POLICE MAN’S TIP
HAND or CORTERS TIP HAND
Dis –ability --------Abducion,
Lateral ------rotation of arm is lost.
Flexion and supination of for-arm lost.
2. Klumpke’s paralysis :
i) Site of injury -------lower trunk of brachial plexus.
ii) Cause a) Undue abducion of arm as in cluthing.
b) Fall from height
c) both injury
iii) Nerve root involve T1 and C8
iv) Muscle paralyse ----------
a) Intrensic muscle of hand
b) Ulnar flexor of wrist and fingure

v) De-formarty -------
a) Claw hand means hyper axtention of metacarpo phalengial
joint and flexion of intra- phalengial joint.
b) Hor ner’s syndorm ---- which constituted of ptosis, Miosis
and hydrosis and enopthalmus, loss of ciliospinal reflex.
Injury to Nerve serratus anterior cause winging of scapula.
 Multiple Choice Questions

1) All of the following are nerves are branches of branchial plexus excepts.
a) Long thoracic nerve
b) Pudendal nerve
c) Dorasal scapular nerve
d) Medial pectoral nerve
2) Erb’s paralysis is injuryto …… trunk of branchial plexus
a) Lower
b) Medial
c) Upper
d) Lateral
3) Injury to lower trunk of branchial plexus is called ………
a) Klumpke’s paralysis
b) Erbs paralysis
c) Horner’s syndrome
d) None of above.
4) The relation of axillary artery is ……
a) Lateral cords of brachial plexus
b) Post. Cords of brachial plexus
c) Both of the above
d) None of above.
5) All of following are post relation of 3rd part of brachial plexus except
…….
a) Radial nerve
 b) Axillary nerve
c) Caracobrachialis
d) Subcutaneous in upper part.
6) All of following are medial relations of 3rd part of branchial plexus
except.
a) Medial cutaneous nerve of arm
b) Medial cutaneous nerve of forarm
c) Medial pectoral
d) Suprascapular nerve
7) All relations of 1st part brachial plexus.
a) Nerve to serratus anterior
b) Nerve to rhomboideus
c) Suprascapular nerve
d) Both a & b
8) Winging of scapula is due to ….
a) Injury to swerratus anterior
b) Injury to subscapularis
c) Injury to supraspinatus
d) Injury to deltoid
9) dislocation of humerus is due to ……
a) injury to lateral cord
b) Injury to anterior cord
c) Injury to medial cord
d) None of above.
10) Injury to medial cord cause …….
a) Subcoracoid dislocation of humerus
b) Subcoraco dislocation of humerus
 c) Caraco humeral dislocation of humerus
d) None of above.
11) Lateral cord is formed by union of ……….
a) Ventral division of upper and middle trunks
b) Ventral division of lower & upper trunks
c) Ventral division of lower and middle trunks.
d) Both b & c
12) Posterior cord is formed by union of …………..
a) Dorsal divisions of all 3 trunks
b) Ventral division of lower trunk.
c) Ventral division of upper trunk.
d) Ventral division of middle trunk.