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Brachial Plexus

The brachial plexus is formed by the ventral rami of cervical and thoracic spinal nerves C5-T1. It provides nerve fibers that innervate the muscles and skin of the upper limb. The plexus has roots, trunks, divisions, cords, and branches that ultimately form nerves like the median, ulnar, radial, and musculocutaneous nerves. These nerves innervate specific muscles in the arm, forearm, and hand as well as areas of skin. Damage to one segment of the brachial plexus cannot completely paralyze a muscle due to overlapping nerve innervation.

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443 views

Brachial Plexus

The brachial plexus is formed by the ventral rami of cervical and thoracic spinal nerves C5-T1. It provides nerve fibers that innervate the muscles and skin of the upper limb. The plexus has roots, trunks, divisions, cords, and branches that ultimately form nerves like the median, ulnar, radial, and musculocutaneous nerves. These nerves innervate specific muscles in the arm, forearm, and hand as well as areas of skin. Damage to one segment of the brachial plexus cannot completely paralyze a muscle due to overlapping nerve innervation.

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api-19916399
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© Attribution Non-Commercial (BY-NC)
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Nerve Plexuses

All ventral rami except T2-T12 form interlacing nerve


networks called plexuses found in the cervical,
brachial, lumbar, and sacral regions
Each resulting branch of a plexus contains fibers from
several spinal nerves
Each muscle receives a nerve supply from more than
one spinal nerve
Damage to one spinal segment cannot completely
paralyze a muscle
Brachial Plexus
Formed by ventral rami of C5-C8 and T1 (C4 and
T2 may also contribute to this plexus)
It gives rise to the nerves that innervate the upper
limb
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• Roots (ventral
rami)
• Trunks
• Divisions
• Cords
• Branches
Roots Combine Forming Trunks
Which Then Split Into Divisions

C5 Anterior Division
Upper Trunk
C6 Posterior Division

Anterior Division
C7 Middle Trunk
Posterior Division

C8 Anterior Division
Lower Trunk
T1 Posterior Division
Divisions Form Cords

• Anterior Lateral Cord


• Posterior
Upper

• Anterior Medial Cord


• Posterior
Middle

• Anterior Posterior Cord


• Posterior
Lower
Cords Form Branches

• Lateral Cord Musculocutaneous n.

Median n.

• Medial Cord Ulnar n.

• Posterior Cord Radial n.


Axillary n.
The Brachial Plexus –
Innervation of the Upper Limb
• Axillary Nerve (Posterior Cord)
– Runs posterior to the neck of the humerus
– Deltoid and teres minor
– Skin over inferior half of deltoid

• Musculocutaneous Nerve (Terminal


Branch of Lateral Cord)
– Anterior arm
– Innervates arm flexors
– Distal to elbow, becomes cutaneous –
sensation on lateral forearm
The Brachial Plexus –
Innervation of the Upper Limb
• Median Nerve (Lateral & Medial Cords)
– Travels with brachial artery in arm, with radial
artery in forearm
– Muscles of flexor compartment of forearm
except flexor carpi ulnaris and medial flexor
digitorum profundus.
– Through carpal tunnel to 5 intrinsic muscles of
hand
– Skin of lateral 2/3 of hand on palm side and
dorsum of fingers 2 and 3
The Brachial Plexus –
Innervation of the Upper Limb
• Ulnar Nerve (Medial cord)
– Descends along medial side of arm
– Passes posterior to medial epicondyle = “”
– Runs with ulnar artery in forearm
– Innervates flexor carpi ulnaris and medial
flexor digitorum profundus in forearm
– Intrinsic muscles of hand except for 5
– Skin of medial 1/3 of hand anteriorly and
posteriorly
The Brachial Plexus –
Innervation of the Upper Limb

• Radial Nerve (Posterior Cord)


– Largest branch of brachial plexus
– Humerus in radial groove supplying posterior
compartment of arm
– Curves anteriorly around lateral epicondyle,
dividing into superficial and deep branch
– Superficial branch to skin on dorsolateral
surface of hand
– Deep branch to extensor muscles of forearm
Superficial and Deep Muscles
• Flexor digitorum superficialis Median n.
• Flexor carpi radialis Median n.
• Pronator teres Median n.
• Palmeris longus Median n.
• Flexor carpi ulnaris Ulnar n.

• Flexor pollicis longus Median n.


• Flexor digitorum profundus Median n. + Ulnar n.
• Pronator quadratus Median n.
Superficial Muscles

• [Brachioradialis]
• Extensor carpi radialis longus & brevis
• Extensor digitorum
• Extensor carpi ulnaris

• Supinator
• Abductor pollicis longus
• Extensor pollicis longus & brevis
• Extensor indicis
Intrinsic Muscles of Hand

• Thenar
– Abductor pollicis brevis Median n.
– Flexor pollicis brevis Median n.
– Opponens pollicis Median n.
– Adductor pollicis Ulnar n.
• Hypothenar
– Abductor digiti minimi Ulnar n.
– Flexor digiti minimi brevis Ulnar n.
– Opponens digiti minimi Ulnar n.
Pg. 311
Intrinsic Muscles - Midpalmar

• Lumbricals
– Medial n. (lateral 2)
– Ulnar n. (medial 2)
• Palmar interossei
– Ulnar n.
• Dorsal interossei
– Ulnar n.
Innervation of Muscles of
Scapula

• Lattisimus dorsi Thoracadorsal n.


• Subscapularis, teres major Subscapular n.
• Supraspinatus, infraspinatus Suprascapular n.
• Teres minor Axillary n.
• Deltoid Axillary n.
• Coracobrachialis Musculocutaneous n.
• Levator scapulae, rhomboids Dorsal scapular n.
• Pectoralis Minor Pectoral n.
• Serratus Ventralis Long thoracic n.
• Trapezius Accessory n.
Muscles – Origin on Scapula

• Movement of arm
– Subscapularis
– Supraspinatus Rotator
– Infraspinatus Cuff
– Teres minor
– Teres major
– Latissimus dorsi
– Corocobrachialis
– Deltoid
Pg. 296

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