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By: Dr. Musaed Al-Fayez

Functions of the Nerves Entering
The Upper Limb

1. Sensory innervation to the skin and joints

2. Motor innervation to the muscles

3. Influence over the diameter of blood vessels via sympathetic

vasomotor nerves

4. Sympathetic secretomotor supply to the sweat glands

What is a Brachial Plexus ?

Brachial Plexus are

complicated plexus of nerves
present at the root of the
neck to enter the upper limb
This allows the nerve fibers
derived from different
segments of the spinal cord to
be arranged and distributed
efficiently in different nerve
trunks to the various parts of
the upper limb
Location & Formation

Brachial Plexus is present in the lower

part of the posterior triangle of the
neck & Axilla

It is formed by the union of the anterior

rami of the 5th, 6th, 7th and 8th cervical
and the 1st thoracic spinal nerves

The Plexus can be divided into:




The roots of C5 & 6 unite to form upper

The root of C7 continues as the middle trunk

The roots of C8 & T1 unite to form lower


Each trunk divides into anterior

Posterior divisions
The anterior divisions of the upper and
middle trunks unite to form the lateral

The anterior division of the lower trunk

continues as the medial cord

The posterior divisions of all three trunks

join to form the posterior trunk
Axillary Sheath

The cords become arranged around

the axillary artery in the axilla

Brachial Plexus, the axillary artery and

vein are enclosed by a sheath of
fascia called AXILLARY SHEATH
Relation of Cords

All three cords of the brachial plexus

above and lateral to the first part of
Relation of Cords
Medial cord crosses behind the artery to
reach the medial side of the second part of
the axillary artery
Posterior cord lies behind the second part of
the artery
Lateral cord lies on the lateral side of the
second part of the artery

The branches of the different parts of


brachial plexus are:

Dorsal scapular nerve (C5)

Long thoracic nerve (C5, 6 and 7)

Upper Trunk:
Nerve to subclavius (C5 and 6)

Suprascapular nerve (supplies the

supraspinatus and infraspinatus
Lateral Cord:
Lateral pectoral nerve

Musculocutaneous nerve

Lateral root of median nerve

Medial Cord:
Medial pectoral nerve

Medial cutaneous nerve of arm and

medial cutaneous nerve of forearm

Ulnar nerve

Medial root of median nerve

Posterior Cord:
Upper and lower subscapular nerves

Thoracodorsal nerve

Axillary nerve

Radial nerve
Branches in Axilla

Nerve to Subclavius:

Supplies the subclavian muscle

May give contribution (C5) to the

Long Thoracic Nerve:

Arises from the root

Enters the axilla by passing down over the

lateral border of the 1st rib behind the
axillary vessels and brachial plexus

Supplies the serratus anterior muscle

Lateral Pectoral Nerve:

Arises from the lateral cord

Supplies the pectoralis major muscle

Musculocutaneous Nerve:

Arises from the lateral cord

Supplies the coracobrachialis muscle

Leaves the axilla by piercing this

Lateral Root of the Median Nerve:

Is a direct continuation of the lateral cord

Is joined by the medial root to form the

median nerve trunk

Gives no branch in the axilla

Medial Pectoral Nerve:

Arises from the medial cord

Supplies and pierces the pectoralis


Supplies the pectoralis major muscle

Medial Cutaneous Nerve of the Arm

Arises from the medial cord

Is joined by intercostobrachial nerve

Supplies the skin on the medial side of

Medial Cutaneous Nerve of the

Arises from the medial cord

Descends in front of the axillary artery

Ulnar Nerve:

Arises from the medial cord

Descends between axillary artery and


Gives no branches in the axilla

Medial Root of the Median Nerve:

Arises from the medial cord

Crosses in front of the 3rd part of axillary


Joins the lateral root of the median nerve

Upper and Lower Subscapular Nerve :

Arise from the posterior cord

Supply the upper and lower part of the

suscapularis muscle and teres muscle
lower subscapular nerve)
Thoracodorsal Nerve:

Arises from the posterior cord

Runs downward to supply the

dorsi muscle
Axillary Nerve:

Is one of the terminal branches of posterior


Gives branch to the shoulder joint

Divides into anterior and posterior

Radial Nerve:

Largest branch of brachial plexus

Lies behind the axillary artery

Supplies the long and medial heads of

Triceps muscle and the posterior
cutaneous nerve of the arm