Anatomy lecture 3 brachial plexus:

Root-trunk-division-cord
Origin and insertion the origin is a base and major one and insertion is the one that will move
Insertion is always going to the origin (insertion is movement)

Brachial plexus:
- Somatic nerve plexus formed by anterior rami of C5 to T1
- Origin in neck then lateral and inferior to axilla over rib 1
- innervate the upper limb from cords (proximal behind subclavian artery and distal
surround axillary artery)
- they give many branches to reach the terminal nerves which innervate the whole arm
forearm and hand like musculocutaneous, radial, median, ulnar

roots:
- anterior rami of C5-T1
- receive gray rami communicantes from sympathetic trunk and then with trunks enter
the posterior triangle of neck behind subclavian artery

trunks:
- superior: union of C5-C6 roots (more superior)
- middle: continuation of C7 roots (more superior)
- inferior: union of C8-T1 (lies on rib 1 post. Subclavian)

divisions:
each of 3 trunks divides to anterior and posterior divisions:
- 3 anterior div. give rise to peripheral nerves ass. With ant. Compartment of arm and
forearm
- 3 posterior div. combine and give rise to nerves of post. Comp

Cords:
named according to position for 2nd part of axillary artery
- Lateral: union of ant. Div. of upper and middle trunks (C5-C7)
- Medial: continuation of ant. Div. of inferior trunk C8-T1
- Posterior: union of 3 post. Div. contributes to all roots C5-T1
So nerves to ant. Comp come from lateral and medial cords and post. Comp from post. Cord

Branches:
Branches of the roots:
1- Dorsal scapular nerve:
- Originates from C5 root
- it goes under the rhomboid major and minor muscles and innervates them
- The origin is the vertebra and insertion is scapula and these muscles help for scapula
adduction or retraction
 2- Long thoracic nerve:
- Originates from ant. Rami of C5-C7
- innervates serratus anterior
- ribs origin and insertion is scapula and movement is abduction

== these are antagonists

In case of hurting the long thoracic nerve I will lose the serratus ant function and will cause all
time adduction and this case is called winged scapula

Branches of the trunks:

Two nerves that originate from superior trunk:

1- Subclavius nerve:
- C5-C6 originates from superior trunk
- under the clavicle nerve going to the subclavius muscle over subclavian artery and vein
(one of the useless muscles)
- origin is the vertebra and the insertion is the clavicle
- it causes depression and elevation of the clavicle (movement of insertion)

2- Suprascapular nerve:
- Originates from superior trunk C5-C6
- Passes through posterior triangle and enter through suprascapular foramen to post.
Scapular region
- above the scapula nerve has 2 branches going to supraspinous fossa and infraspinous
fossa divided by the spine
- muscles innervated are supraspinatus and infraspinatus above and below the spine
respectively
- the humerus is the origin and insertion is the scapula.
- the supraspinatus muscle helps in abduction if raising the arm more than 90 degree
- While infraspinatus causes lateral rotation and extension with origin humerus and
insertion scapula

Axillary nerve: C5-C6 comes from backward and circles around neck of humerus and innervates
teres minor and deltoid (abduction major of shoulder) and it has skin sensation function. Teres
minor and infraspinatus have same function but diff innervation. Both lateral rotation and
extension same origin and insertion.

Branches of cords:
Lateral cord: 3 C5-C7
1- Lateral pectoral nerve: C5-C7
- innervates pectoralis major muscle and used for adduction of hand.
- Pectoralis major is innervated by lateral (innervates the lateral part) and medial pectoral
nerve (innervates the medial part)
 2- Musculocutaneous nerve:
- Large terminal branch that innervates all 3 flexor muscles in ant. Arm and ends as lateral
cutaneous nerve of forearm
o Coracobrachialis
o Biceps brachii
o Brachialis

3- Lateral root of median nerve

Medial cord: 5 C8-T1

- Ulnar nerve
- Median nerve partially
- Medial pectoral: C8-T1 medial
o Innervates medial pectoralis major muscle part and pectoralis minor (abduction
and flexion for 1st and protraction of 2nd)
- Medial brachial cutaneous nerve T1 sensory info from arm skin
- Medial antebrachial cutaneous nerve C8-T1 sensory info from forearm

Posterior cord: 5 C5-T1

- superior subscapular nerve C5-C6
o innervates the upper portion of subscapularis
o internal rotation and adduction of humeral head
- thoracodorsal nerve (middle subscapular nerve) C6-7-8
o innervates latissimus dorsi
o extension, adduction and medial rotation of humerus
- inferior subscapular nerve C5-6
o innervates subscapularis and teres major
o adduction and medial rotation of arm
- axillary nerve
- radial nerve
Now for 4 bosses:
Anterior part of arm forearm and hand is flexion and posterior is for extension

Anterior part innervated by:

- Arm: Musculocutaneous nerve C5-C7 lateral cord is sensory for muscles under the skin
o biceps brachii origin is scapula insertion is elbow joint, function is flexion of
elbow and shoulder
o coracobrachialis muscle used for shoulder flexion (coracoid of scapula)
o brachialis muscle for flexion of the elbow (80% by ML but 20% by radial nerve
innervated also)
o ML also innervates skin on lateral forearm and ant part of arm
- Forearm: whole compartment supplied by median nerve C5-T1 which is the boss except
these are supplied by ulnar nerve
o Flexor carpi ulnaris: flexion of wrist at ulnar bone
 We have flexor carpi radialis flexion of wrist at radial bone
o Flexor digitorum profundus: which ends at DIP and works for flexion of digits at
DIP and the last 2 fingers are innervated by ulnar nerve (posterior and anterior)
while the 2 fingers plus thumb by median nerve anteriorly and the tips of fingers
posteriorly and by radial nerve posteriorly
 We have flexor digitorum superficialis ends at PIP
o radial nerve to the brachioradialis muscle which is the only muscle working in
case the midprone position and is called the drinking muscle
- Hand: ulnar and median (ulnar little bit boss)

posterior of all hand (forearm and arm and hand) we have 1 boss:
- Arm: radial nerve C5-T1
o Triceps brachii: for extension of the elbow joint
o Anconeus muscles: stabilize and supination of elbow
- Forearm: extension of wrist ad fingers and all supplied by radial nerve
- radial nerve but sometimes it acts as occupant and parasite and goes to the front ant
side as well to brachialis
o Radial is the only nerve that crosses the humerus

Note: We have the metacarpals under the wrist joint and then the phalanges between them the
MCP metacarpals phalanges joint then after phalanges we have 2 joints
the distal and the proximal phalanges joints (PIP and DIP)
Even though nerves go through brachial plexus, the segmental innervation to the muscles of the
upper limbs has a proximal–distal gradient, i.e., the more proximal muscles are innervated by
the higher segments (C5 and C6) and the more distal muscles are innervated by the lower
segments (C8 and T1).
- Therefore, the intrinsic shoulder muscles are innervated by C5 and C6,
- The intrinsic hand muscles are innervated by C8 and T1
- The distal arm and proximal forearm muscles are innervated by C6 and C7,
- The more distal forearm muscles are innervated by C7 and C8