Brachial

plexus

Where Ventral Rami Come From

Dorsal
Root

Dorsal
Ramus of
spinal nerve
Ventral
Ramus of
spinal nerve
spinal
nerve

Ventral

Parts of Brachial Plexus

R = ROOTS (ventral rami)

T = TRUNKS
D = DIVISIONS
C = CORDS
B = BRANCHES

Relationship of cords of brachial

plexus with
axillary artery

PUT IT ALL TOGETHER...

BRANCHES OF
SUPRACLAVICULAR PART OF
BRACHIAL PLEXUS
Branches of roots Dorsal scapular nerve(C5)
Long thoracic nerve
(C5,C6,C7)

muscular branches to
longus colli &
scaleni
Branch to phrenic nerve

Branches of upper-

Nerve to subclavius

(C5,C6)

Trunk
(C5,C6)

Suprascapular nerve

BRANCHES OF INFRACLAVICULAR PART OF

BRACHIAL PLEXUS
Lateral cord
Musculocutaneous nerve(C5,C6)
Lateral pectoral nerve
(C5,C6)

Lateral root of median

nerve (C5,C6)
Medial cord
Medial cutaneous nerve of
arm (C8,T1)
Medial
cutaneous nerve of forearm(C8,T1)
Medial root of median
nerve(C8,T1)
Medial pectoral nerve
(C8,T1)

Posterior cord

Ulnar nerve(C7,C8,T1)
Upper subscapular

BRANCHES OF ROOTS
DORSAL SCAPULAR NERVE

Root value- C5
Supply Rhomboid major &
minor muscle

Posterior view

LONG THORACIC
NERVE
Root value- C5,C6,C7
Supply Serratus
anterior muscle

BRANCHES OF UPPER
TRUNK
NERVE TO SUBCLAVIUS
Root value C5,C6

SUPRASCAPULAR NERVE
Root value C5,C6

LATERAL PECTORAL
NERVE

Root valueC5,C6,C7

MEDIAL PECTORAL NERVE

Root value- C8,T1

MUSCULOCUTANEOUS
NERVE
Root value C5,C6,C7

MEDIAN NERVE

12-13

MEDIAL CUTANEOUS NERVE OF ARM

oot value- C8,T1

MEDIAL CUTANEOUS NERVE OF

FOREARM
oot value- C8,T1

ULNAR NERVE
Root value-(C7),C8,T1

12-15

PPER SUBSCAPULAR
oot value-C5,C6

OWER SUBSCAPULAR
oot value- C5,C6

ERVE TO LATISSIMUS DORSI

oot value-C6,C7,C8

AXILLARY NERVE

RADIAL NERVE

DERMATOMES OF UPPER LIMB

APPLIED ANATOMY

TENDON REFLEXES
Biceps brachii tendon reflexe (C5,C6)
Triceps tendon reflex (C6,C7,C8)
Brachioradialis tendon reflex(C5,C6,C7)

LONG THORACIC NERVE

Causes - carrying Heavy load on
shoulder
Sudden pressure on
shoulder
from above
Deformity Winging of scapula
Overhead abduction
not possible

ERBS
PARALYSIS
Erbs point
Causes
Nerve roots
involved
Muscles Paralysed
Deformity
Disability

LEFT SIDE PARALYSIS

Klumpkes paralysis-

Site of injury

Cause of injury

Nerve roots involved

Muscles paralysed

Deformity

Disability

CLAW HAND

HORNER SYNDROME

MUSCULOCUTANEOUS NERVE
Cause
Muscle paralysed
Disability

SUPRASCAPULAR
NERVE
Cause
Muscle paralysed
Disability

AXILLARY
NERVE
Causes

crutch pressing upward into

the armpit,
Downward
shoulder
dislocations
fractures of the surgical
neck of the humerus.

Motor effects:

Sensory effects:
Deformity:

MEDIAN NERVE
CauseSite of injuryMuscles paralysedDeformity
Disability

RIGHT SIDE

ULNAR NERVE
CausesAxilla- crutch pressure
Arm- # of shaft of humerus
Elbow- # of medial epicondyle
Forearm- penetrating injuries
Wrist- cut and stab wounds
Muscles paralysedDeformity
Disability

RADIAL NERVE
CauseSite of injuryMuscles paralysedDeformity
Disability

DIAGNOSIS

Relies mainly on clinical examination

No specific lab. Studies
CT myelography
MRI
Nerve conduction studies

TREATMENT
Most injuries recover without any Rx
Rx is done in very highly specialized
centers
Surgical options
a. nerve transfers
b. nerve graft
c. muscle transfers
d. neurolysis of scar around the
brachial plexus in incomplete lesions.

BRACHIAL PLEXUS BLOCK

Supraclavicular approach

Axillary approach

Roots join to form Trunks!

(in neck)
Ventral Rami

C5
C6
C7
C8
T1

Trunks

Upper Trunk
Middle Trunk
Lower Trunk

Trunks Split to form Divisions!

Trunks
Upper
Posterior
Middle
Posterior
Lower
Posterior

(in neck)
Divisions
Anterior

Anterior

Anterior

Divisions Join to form Cords!

Trunks

U
M
L

Divisions

A
A

axilla)

Cords

P
LATERAL
CORD
P

A
P
MEDIAL
CORD
POSTERIOR CORD

(in

Musculocutaneous Nerve
Course

Motor components

Sensory: Skin along lateral

surface of forearm

 Effects:
Motor: paralysis of
the supraspinatus,
infraspinatus,
subclavius,
biceps brachii,
part of brachialis,
coracobrachialis;
deltoid
teres minor.
Sensroy: sensory loss on the lateral side of the arm.

Deformity:
waiter tip postion
a.limb will hang by the side,
b.medially rotated by sternocostal part of the pectoralis
major;
c. pronated forearm (biceps paralysis)

Motor effects:paralysis of
triceps
Anconeus
extensors of the wrist
Extensors of fingers.
Brachioradialis
supinator muscle
Deformity: Wrist and finger drop

Sensory effects :
small area of sensation loss at arm and
forearm
sensory loss over lateral part of the dorsum
of the
hand (lat. 3.5 fingers without distal
phalynges)

Test for ulnar nerve

Card test
Froments sign
Egawas test

AXILLA
CONTENT
Axillary artery & its
branches
Axillary vein & its
tributaries
Infraclavicular part of
brachial plexus
Axillary lymph nodes
Axillary fat

arpal tunnel syndrome

pidemiology

gns &symptoms

otor changes

ensory changes

asomotor changes

ophic changes

Tests done

Tinel sign
Phalens maneavure

Radial Nerve
Injury in axilla
Causes of injury
Motor effects:paralysis

of

triceps,anconeus
extensors of the wrist
Extensors of fingers.
Brachioradialis
supinator muscle

Deformity: Wrist and finger drop

Sensory effects -small area of sensation loss at arm
andforearm
sensory loss over lateral part of the dorsum of the
hand (lat. 3.5 fingers without distal phalynges)

Injuries at Spiral Groove

Caused by fracture shaft of humerus.
Motor effects: paralysis of
extensors of the wrist
Extensors of fingers

Deformity:
Wrist and finger drop

Sensory effects:
anesthesia is present over the dorsal
surface of the hand (lat. 3.5 fingers)