Brachial Plexus

Ventral and dorsal primary rami of spinal nerve 2

Human Anatomy/Yogesh Sontakke 3
 BRACHIAL PLEXUS
• Brachial plexus is the nerve plexus that is derived from ventral primary
rami of lower four cervical spinal nerves (C5–C8) and first thoracic spinal
nerve (T1).
Components of Brachial Plexus
• Brachial plexus consists of the following components
1. Roots: Ventral primary rami of C5–C8 and T1 nerves.
2. Trunks: Three trunks derived from roots (upper, middle, and lower).
3. Divisions: Each trunk divides into anterior and posterior divisions.
4. Cords: Divisions join to form three cords (medial, lateral, and posterior).
5. Branches: Various nerves arise from each cord.
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Formation and branches of
brachial plexus (right)

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 Trunks
Relations
• Trunks of brachial plexus lies in the neck.
• They emerge between scalenus anterior and scalenus medius muscles.
• Trunks descend downward and laterally.
• Lower trunk passes posterior to the subclavian artery, whereas upper
and middle trunks pass behind the artery.

Divisions
• Each trunk divides into anterior and posterior divisions.
Relations
• Trunks divide in the lowest part of the neck to form divisions.
• These divisions enter the axilla through cervico-axillary canal where they
form cords. 8
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Cords
• Divisions join to form three cords: Medial, lateral, and posterior.
– Lateral cord formed by union of ventral divisions of upper and middle trunks
– Medial cords as a continuation of ventral divisions of lower trunk
– Posterior cords formed by union of dorsal divisions of all trunks. Neet
Relations
• Cords and their branches form infraclavicular part of the brachial plexus.Viva
• Relation with 1st part of axillary artery:
Medial and posterior cords lie behind the artery, whereas lateral cord lies laterally.
• Relations with 2nd part of axillary artery:
Medial cord lies medial, posterior cord lies posterior, and lateral cord lies lateral to
the artery.
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Course and relations
• Roots & trunks- Posterior triangle of the neck
• Divisions, cords & branches - Axilla

• Cords- related to 1st & 2nd part of axillary artery

• Branches – related to the 3rd part of axillary artery

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Phrenic nerve
N. to longus
coli & scalene
muscles

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•Injuries brachial plexus may cause
– Erb’s paralysis
– Klumpke’s paralysis
– Injury to nerve of Bell
• Cervical rib: Occasionally, a rudimentary
additional rib in the neck called cervical
rib may be present. Sometime cervical rib
compresses T1 nerve root.
• Brachial plexus block: Brachial plexus
block can be done by injecting anesthetic
agent to paralyze and anesthetize the
upper limb. It should be done under
ultrasound guidance to avoid injury to
nerves and vessels
• Upper trunk is the most common site of
brachial plexus injuries. Brachial plexus block
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Erb’s paralysis

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Klumpke’s paralysis

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Features of Horner’s syndrome (right eye is affected, whereas left eye is normal
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Winging of the scapula
• Injury to long thoracic nerve
and paralysis of serratus
anterior muscle

•undue prominence of the

medial border of the scapula
when the patient attempts
pushing or punching
movements

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