Brachial Plexus
D.Rania Gabr
D.Sama-ul-Haque
D.Elsherbiny
Objectives
• Describe the brachial plexus
• Make a list of contributing spinal nerves.
• Discuss the general arrangement of this
plexus.
• Locate the plexus in the axilla and note
important relations to blood vessels.
• Make a list of the terminal main branches of
brachial plexus.
Location of Brachial plexus
Brachial Plexus
Def: nerve supply of upper limb.
Formation: It is formed by the union of the anterior Rami
of the C 5th, 6th, 7th & 8th and T1 spinal nerve.
Roots…….trunks……division……cords…..branches
Site:
Roots & Trunks: in the posterior∆
Divisions: behind the clavicle (in cervico-axillary canal).
Cords & Branches: in the axilla
Brachial Plexus
Roots : C5,6,7,8 and T1.
Trunk:
1. Upper trunk: union of C5.6
2. Middle trunk: C7.
3. Lower trunk : union of C8 and T1.
Division; each trunk divides into anterior and posterior.
Cords;
1. Lateral cord: union of anterior division of upper and
middle trunk.
2. Medial cord: anterior division of lower trunk.
3. Posterior cord: union of posterior division of upper,
middle and lower trunk.
Branches Brachial Plexus
(A) From Roots:
1. C5: Nerve to
rhomboids (dorsal
scapular nerve).
2. C5,6 &7: Long
thoracic nerve
(B) From Trunks (upper
trunk):
1. Nerve to subclavius
2. Suprascapular nerve
(C)Branches from the cords:
Lateral Cord
C5
C6
C7
(2LM)
.Lateral pectoral n
.Lateral root to median n
.Musculocutaneous n
C8
T1
Medial cord
(4MU)
.Medial pectoral n.
.Medial root to median n.
.Medial cutaneous n of arm.
.Medial cutaneous n of forearm.
.Ulnar n.
Posterior Cord
(ULTRA)
.Upper subscapular n
.Lower subscapular n
.Thoracodorsal n
.Radial n
.Axillary n
Lateral cord-3
Medial cord-5
Posterior cord-5
Lateral pectoral nerve.
Medial pectoral nerve.
Axillary nerve.
Musculocutaneous nerve.
Ulnar nerve.
Radial nerve.
Median nerve (lateral root).
Median nerve (medial root).
Upper & lower subscapular
nerves.
Medial cutaneous nerve of
arm & forearm.
Thoracodorsal or N. to
latissimus dorsi.
Relations of Brachial plexus
Posterior
Posterior
cord
Lateral
Lateral
cord
Axillary
artery
Anterior
Medial
cord
Axillary vein
Medial
Brachial Plexus Injuries
Nerve injury is manifested by:
1. Loss of sensation: in the area of cutaneous
distribution.
2. Paralysis of voluntary muscles supplied.
3. Wasting of paralyzed muscles.
Lesions of the upper trunk C5,6
ERB'S paralysis
Cause: Birth injury.
The most commonly involved
nerves:suprascapular nerve,
musculocutaneous, and axillary
nerve:
Muscles atrophy:
a. Muscles of shoulder.
b. Flexors of elbow.
c. Extensors of finger.
Policeman (waiter) tips paralysis
a. Adduction of the arm.
b. Extension of the elbow.
c. Pronation of the forearm.
d. Flexion of the fingers.
Falling on
Shoulder
Excessive Stretching
Direct Blow
Lesions of the lower trunk (C8,T1)
Klumpke paralysis or Palsy
Cause: Cervical rib
(compression of the lower
trunk and subclavian artery).
Deformity: Flail (claw) hand.
Muscles atrophy: All the
intrinsic muscles of the hand.
Baby’s upper limb is pulled excessively during
delivery
Claw
Hand