Brachial Plexus

Dr. Sama-ul-Haque
Dr. Nivin Sharaf

BRACHILAL PLEXUS
The brachial plexus is a somatic nerve plexus formed by
intercommunications among the ventral rami of the lower four
cervical nerves ( C 5 - C 8) and the first thoracic nerve (T
1). The plexus is responsible for the motor innervation to all of
the muscles of the upper limb with the exception of the
trapezius and levator scapula.), and the sensory innervation of
the upper limb except an area just above the point of the
shoulder (supplied by supraclavicular nerves) and the dorsal
scapular area which is supplied by cutaneous branches of
dorsal rami.

Spinal Nerve

FORMATION OF THE BRACHIAL PLEXUS

Roots
The ventral rami of spinal nerves C5 to T1 are referred to as the
roots of the plexus.
Trunks
Shortly after emerging from the intervertebral foramina , these 5
roots unite to form three trunks.
The ventral rami of C5 & C6 unite to form the Upper Trunk.
The ventral ramus of C 7 continues as the Middle Trunk.

The ventral rami of C 8 & T 1 unite to form the Lower

Trunk.

Divisions
Each trunk splits into an anterior division and a posterior division.
The anterior divisions usually supply flexor muscles
The posterior divisions usually supply extensor muscles

Location of Brachial plexus

Relations of Brachial plexus

FORMATION OF THE BRACHIAL PLEXUS

CONT.
Cords
The anterior divisions of the upper and middle trunks unite to form
the lateral cord.
The anterior division of the lower trunk forms the medial cord.
All 3 posterior divisions from each of the 3 cords all unite to form the
posterior cord.

The cords are named according to their position relative to the axillary artery

Terminal branches:

Musculo Cutaneous
Ulnar n.
Median n.
Axillary n.
Radial n.

Relations of Brachial plexus

Brachial Plexus

Relation with Axillary Artery

Postfixed Brachial Plexus

Brachial Plexus Injuries

The brachial plexus lies in the posterior triangle

of the neck between the scalenus anterior and
scalenus medius muscles. At the root of the
neck, it lies behind the clavicle.
The most common injury is severe traction with
the arm in abduction e.g. after a motor cycle
accident. Partial paralysis may also result from
shoulder dislocation. Direct injury to the brachial
plexus can result from a stab or gunshot wound.
:

Brachial Plexus Injuries

In Adults:
Sports most commonly associated:
Football, baseball, basketball,
volleyball, wrestling, and
gymnastics.
Nerve injuries can result from:
Blunt force trauma, poor posture or
chronic repetitive stress.

Brachial Plexus Injuries

Patients generally present with pain

and/or muscle weakness.

Some patients may experience

muscle atrophy.

Brachial Plexus Injuries

Result:
Anesthesia
Paralysis
1. Complete
2. Incomplete

Erb- Duchenne palsy

Injury to Superior part of Plexus.
Occurrence:
Due to excessive increase in the angle
between neck and the shoulder.
Roots Involved:
C5 and C6
Muscles Involved:
Shoulder
Arm

Vacuum Extractor delivery

Forceps delivery

Falling on
Shoulder

Excessive Stretching

Direct Blow

What is
Waiters tip or
Porters tip
position?

Erb- Duchenne palsy

Clinical Appearance:
Motor Loss:
Adducted Shoulder
Medially Rotated Arm
Extended Elbow
Sensory Loss:
Lateral aspect of Upper Limb (uncommon)

Waiters tip position

Characteristic position - adduction and
internal rotation of the arm with forearm
pronated
Forearm extension normal
Biceps reflex absent

Waiters tip palsy

Erb's palsy is caused by damage to the
brachial plexus during delivery of the
neonate. This is mostly limited to the
5th and 6th cervical nerves

klumpke paralysis or Palsy

Injury to Inferior part of Plexus.
Occurrence:
Excessive abduction of arm.
Less common then Injury to Superior part of
Plexus.
Roots Involved:
C8 and T1

klumpke paralysis or Palsy

Clinical Appearance:
Motor Loss:
Small muscles of Hand
Sensory Loss:
Medial aspect of Upper Limb

Person grasping something to prevent a fall

Babys upper limb is pulled excessively during

delivery

Claw Hand
Aetiology:
brachial plexus lesion (C8T1),Ulnar, and/ or Median
nerve injury
This occurs when all
fingers are clawed. It is the
result of hyperextension at
the metacarpophalangeal
joints and flexion of the
interphalangeal joints.

Claw
Hand

Cervical
Rib
Involves
Inferior part
of Plexus

References
http://www.upstate.edu/cdb/education/g
rossanat/limbs2.shtml
www.medicalstudent.com
www.netteranatomy.com

Thank You