BRACHIAL PLEXUS

Dr Muthoka Mativo

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OBJECTIVES
 Formation of a spinal nerve
 What is brachial plexus
 Formation of the plexus
 Branches
 Applied anatomy

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SPINAL NERVE

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 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

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CORDS OF BRACHIAL PLEXUS
 Formed from divisions.

 Accompany axillary artery.

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CORDS OF BRACHIAL PLEXUS
 Named for relationship to artery.
Lateral: From anterior divisions of upper and middle
trunks.

Posterior: From posterior divisions of all trunks.

Medial: From anterior divisions of lower trunk.

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LATERAL CORD
 Branches:
Lateral pectoral nerve, C5-7
- innervates pectoralis major muscle
Musculocutaneous, C5-7
-Innervates biceps brachii and other muscles of
anterior arm
Lateral root of median nerve, C5-7

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MEDIAL CORD:BRANCHES
 Medial pectoral nerve:
C8-T1

 Medial cutaneous nerve to arm (brachium)

 Medial cutaneous nerve to forearm (antebrachium)

 Ulnar
C8-T1
 Medial root of median nerve
C8-T1
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POSTERIOR CORD
 Upper subscapular nerve:
C5-6
To subscapularis muscle
 Thoracodorsal nerve:
C6-7
To latissimus dorsi muscle
 Lower subscapular nerve:
C5-6
To subscapularis and teres major
muscles

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POSTERIOR CORD CONT’D
 Axillary nerve:
C5-6
Motor:
To deltoid and teres minor muscles.
Sensory:
Skin on arm over deltoid muscle:
Upper lateral cutaneous nerve

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POSTERIOR CORD CONT’D
 Radial nerve:
C5-T1
Motor:
Posterior compartments of arm and
forearm.
Brachioradialis muscle
Sensory:
Back of arm, forearm, hand

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BRACHIAL PLEXUS

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RELATION WITH AXILLARY ARTERY

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APPLIED ASPECTS
 Post-fixed and pre-fixed plexus

 Erb’s palsy

 Klumpke’s palsy

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Postfixed Brachial Plexus

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ERB- DUCHENNE PALSY
 Injury to Superior part of Plexus.

Due to excessive increase in the angle

between neck and the shoulder.

 Roots Involved:
 C5 and C6

 Muscles Involved:
 Shoulder
 Arm

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 What is
Waiter’s tip or Porter’s tip
position?

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

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WAITER’S TIP POSITION

 Characteristic position - adduction and

internal rotation of the arm with forearm
pronated

 Forearm extension normal

 Biceps reflex absent

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KLUMPKE PARALYSIS OR PALSY
 Injury to Inferior part of Plexus.

 Excessive abduction of arm.

Less common then Injury to Superior part of

Plexus.

 Roots Involved:
 C8 and T1
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KLUMPKE PARALYSIS OR PALSY

 Clinical Appearance:

 Motor Loss:
 Small muscles of Hand

 Sensory Loss:
 Medial aspect of Upper Limb

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PERSON GRASPING SOMETHING TO PREVENT A FALL

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BABY’S UPPER LIMB IS PULLED EXCESSIVELY
DURING DELIVERY

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CLAW HAND

Aetiology:

brachial plexus lesion (C8-

T1),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.

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CERVICAL RIB

Involves
Inferior part
of Plexus

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 THANK YOU

‘BETTER THE END THAN THE BEGINNING..’

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