Brachial plexus

Introduction

The brachial plexus passes from the neck to the axilla and supplies the upper limb. It is
formed from the ventral rami of the sth to 8th cervical nerves and the ascending part of
the ventral ramus of the 1st thoracic nerve. Branches from the 4th cervical and the 2nd
thoracic ventral ramus may contribute.

Compression of the medial, lateral and posterior cords of the brachial plexus can occur

between the first rib and clavicle (known as thoracic outlet) and below pectoralis minor

ANTERIOR
DIVISION OP DESCENoING
FOURTH CERVICAL RANCH O
MYPOGLOsSAL
DORSALIS-

sCAPULAE ANSA
MYPOGLOsS

LONG PHRENIg
THORACIC

sUPRASCAPULAR

LAVICLE!
THYROIDD
AXIS
INTERNAL
MAMMARY
ARTERY

sUDCLAVIAN

CLAVICLE

DRANCH TO
PHRENICC

ANTERIO
THORACIa

POeroRA

The right brachial plexus with its short branches. viewed from in front.

Function

The brachial plexus is responsible for cutaneous and muscular innervation of the entire
upper limb, with two exceptions: the trapezius muscle innervated by the spinal accessory

nerve (CN XI) and an area of skin near the axilla innervated by the intercostobrachial
nerve2
Description

Pathl314]

The brachial plexus is divided into Roots, Trunks, Divisions, Cords, and Branches. There

are five "terminal" branches and numerous other "pre-terminal" or "collateral" branches

that leave the plexus at various points along its length.

The five Roots are the five anterior rami of the lower four cervical and first thoracic
nerve roots (Cs-C8, Ti) after they have given off their segmental supply to the muscles
of the neck. These Roots merge to form three Trunks:

Upper Trunk (C5-C6)

Middle Trunk (C7)

Lower Trunk (C8, T1)

Each Trunk then splits into anterior and posterior divisions, to form six Divisions.
The anterior/ posterior divisions innervate flexor groups versus extensor groups
anterior divisions of the upper, middle, and lower trunks
posterior divisions of the upper, middle, and lower trunks

These six Divisions will regroup to become the three Cords. The Cords are named by
their position to the axillary artery.

The Posterior Cord is formed from the three posterior divisions of the trunks (C5-
C8, T1
The Lateral Cord is the anterior divisions from the upper and middle trunks (C5
C7)
The Medial Cord is simply a continuation of the anterior division of the lower
trunk (C8, T1)

Cords Divisions Trunks Roots

C5
Dorsal scapular nerve

uprascapuiar nerv

C6

Nerve to subclavius
C7

Lateral pectoral nerve -

c8

Musc ulbcutaneous nerve

Medial cord Long u o r a c i c nerve

Axllary nerve

Upper subscapular nerve

Medial pectoral nerve

Thoraco dorsal nerve

Median nerve
LOwe suOscapuiar nerve

Uhar nerve Radial nerve

Medial cutaneous nere of the arm

Med lal cutaneous nenve of the forearm

Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions, and
cords marked
Specific Branches

The branches are listed below. They mostly branch from the cords, but some
originate
from earlier structures.

From Nerve Roots Muscles Cutaneouus

roots Dorsal scapular C4. Rhomboid muscles and
nerrve C5 Levator scapulae

roots Long thoracic nerve C5, Serratus anterior

C6,
C7

upper Nerve to the C5 Subclavius muscle

trunk subclavius C6
upper Suprascapular 5 Supraspinatus and
trunk nerve C6 Infraspinatus
lateral Lateral pectoral C5, Pectoralis major and
cord nerrve 6, Pectoralis minor (by
C7 communicating with the
Medial pectoral nerve)
lateral MusculocutaneousC5, Coracobrachialis, becomes the
cord rve C6, Brachialis and Biceps Lateral cutaneous
C7 brachii nerve of the
forearm
lateral lateral root of the C6, fibres to the median
cord Median nerve C7 nerve

posterior Upper subscapular Cs Subscapularis (upper

cord ner C6
part)
posterior Thoracodorsal nerve C6, Latissimus dorsi
cord (middle subscapular C7, C8
nerv

posterior Lower subscapular C5, subscapularis (lower part

cord nerve C6 and Teres major
posterior Axillary nerve C5, anterior branch: deltoid posterior branch
cord C6 and a small area of becomes Upper
overlying skin posterior lateral cutaneous
branch: Teres minor and nerve of the arm
deltoid muscles

posterior Radial nerve C5. Triceps brachii, skin of the

cord C6, Supinator, Anconeus, the posterior arm as
C7 extensor muscles of the the Posterior
C8, T1 Forearm, and cutaneous nerve
Brachioradialis of the arm

medial Medial pectoral C8, T1 Pectoralis major and

cord nerve Pectoralis minor
medial medial root of the C8, T1 fibres to the median portions of hand
cord Median nerve rve not served by
ulnar or radial

medial Medial cutaneous C8, T1 front and medial

cord nerve of the arm skin of the Arm

medial Medial cutaneous C8, T medial skin of the

cord nerve of the forearm forearm

medial Ulnar nerve C8, Ti Flexor carpi ulnaris, the the skin of the
cord medial two bellies of medial side of the
Flexor digitorum hand and medial
profundus, the intrinsic one and a half
hand muscles except the fingers on the
Thenar muscles and the palmar side and
two most lateral medial two and a
lumbricals half fingers on
the dorsal side
 dorsal scapular Cs
C5
rhomboids * levator scapulae
suprascapular C5/C6
supraspinatus + infraspinatus
THE BRACHIAL PLEXUS
to subclavius C5/C6
ANTERIOR
LATERAL CORD MUSCULOCUTANEOUS
SUPERIOR TRUNK C5/C6/C7

C6 POSTERIOR lateral pectoral C5/C6/7

pectoralis major

AXILLARY
ANTERIORR C5/C6

POSTERIORcORD
C7- MIDDLE TRUNK POSTERIOR
RADIAL
C5/C6/C7/C8/T1
upper subscapular C5/C6
subscapularis
lower subscapular C5/C6
subscapularis + teres major
LATERAL RO T
MEDIAN

thoracodorsal C6/C7/C8
MEDIALROOT

CS/C6/C7/c8/T1
C8 OSTERIOR latissimus dorsi

MEDIAL CORD
ULNAR
INFERIOR TRUNK ANTERIOR
c8/T1

T1 medial pectoral C8/T1

pectoralis major + minor
medial cutaneous
nerve of forearm C8

medial cutaneous
first intercostal Ti
nerve of arm Ti GEEKY MEDICS
OLIWATSOM 2015
long thoracic C5/C6/C7
serratus anterior

NERVE ROOTSx5 TRUNKSx3 DIVISIONSx6 cORDS x3 TERMINAL BRANCHES x5

CS, C6, C7, c8, T1)
exit vertebral foramina between anterior and
medial scalene muscles in posterior triangie of neck
03 EXTRA BRANCHES O
dorsal scopulor, first intercostol, long thorocic
(superior, middle, inferior)
cross posterior triangle, over
first rib, behind subclavian artery
02 EXTRA BRANCHES
suprascapular, n. to subclavius
(3 x anterlor, 3 x posterlor)
located posterior to middle
distributed around second part of axilary artery
third of clavicle; anterior
flexors, posterior = extensors
BRANCHES o
NO EXTRA
(lateral, posterior, medlal)
(musculocutaneous, axllary, radial, median, ulnar)
origins are distributed around third part of axillary artery
O7 EXTRA BRANCHES O medial + laterat
pectoral, upper + lower subscopular,
ALWAYS FIND THE "M" SHAPE MMEDIAN
NOW YOU CAN CONQUER THE BRACHIAL PLEXUS!
thoracodorsal, med. cut. n. of arm +forearm
The brachial plexus is easier to understand once broken down into its component segments: these are roots, trunks,
divisions, cords and terminal branches.

Roots
There are five nerve roots from C5-T1, which give three nerve branches:

Dorsal scapular nerve

Long thoracic nerve
First intercostal nerve

It is important to remember that C5 also gives fibres which join fibres from C3 and C4 to form the phrenic nerve,
which is not shown in the diagram.

Trunks
The five nerve roots combine to form three trunks:

The superior trunk is formed from c5 and c6

The middle trunk is formed from C7
The inferior trunk is formed from C8 and T1

The superior trunk gives rise to two nerve branches: the suprascapular nerve and the nerve to subclavius. The middle
and inferior trunks do not give off any extra branches.

Divisions
There are six divisions in total, comprising of an anterior division and a posterior division from each of the three
trunks:

Anterior division fibres usually supply flexor muscles

Posterior division fibres usually supply extensors

There are no extra nerve branches arising from the divisions

Cords
The divisions combine to form three cords, which are distributed around the axillary artery:

The lateral cord is formed from the anterior divisions of the superior and middle trunks. It gives one extra nerve
branch: the lateral pectoral nerve.
The posteriorcord is formed from the posterior divisions of the superior, middle and inferior trunks. It gives three
nerve branches: the upper subscapular nerve, the thoracodorsal nerve and the lower subscapular nerve.
.The medial cord is formed from the anterior division of the inferior trunk. It gives three nerve branches: the medial
pectoral nerve, the medial cutaneous nerve of the arm (also known as the medial brachial cutaneous nerve) and the
medial cutaneous nerve of the forearm (also known as the medial antebrachial cutaneous nerve).

Terminal branches
The three cords branch to form five terminal nerve branches which supply the upper limb:

The lateral cord gives rise to the musculocutaneous nerve and the lateral root of the median nerve
The posterior cord gives rise to the axillary nerve and the radial nerve
The medial cord gives rise to the medial root of the median nerve and the ulnar nerve

ldentifying structures
It is easy to panic when given a diagram or prosection of the brachial plexus to label in exams. The key is to look for
the "M" shape formed around the axillary artery by the musculocutaneous, median and ulnar nerves.

This is an easy landmark to find and will give you your bearings. Once you have found this, you should be able to
confidently identify those three nerves. You will then be able to identify the small axillary nerve and large radial nerve
originating from the posterior cord behind the axillary artery.

The medial cutaneous nerves of the arm and forearm can be found travelling down the arm below the ulnar nerve.
The three branches from the posterior cord should also be easy to spot, you will see the two small subscapular
nerves and the large thoracodorsal nerve between them, which forms a bundle with the thoracodorsal artery an
to supply atissimus dorsi.