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Updated: Jan 3 2022

Brachial Plexus

Images Plexus with sensory 566_moved.jpg
  • Introduction
    • Standard: C5, C6, C7, C8, T1 – 77% of patients
    • Prefixed: Prefixed (contributions from C3, C4) – 22%
    • Postfixed (roots caudal to T1) – 1%
  • Anatomy
    • Remember: Robert Turner Drinks Cold Beer
    • Roots (5): ventral rami of C5-T1, superior and posterior to subclavian
      • dorsal scapular nerve (C5): through levator scapula to supply levator scapula, rhomboid major & minor
      • long thoracic nerve (C5, 6, 7): posterior to plexus onto thoracic wall to supply serratus anterior
    • Trunks (3): emerge from triangle formed by anterior scalene, middle scalene, first rib
      • superior (C5,6 roots)
        • suprascapular nerve (C5, 6): through suprascapular notch to supraspinatus, infraspinatus, AC and glenohumeral joints
        • nerve to subclavius (C5, 6)
      • middle (C7)
      • inferior (C8, T1)
    • Divisions (6): 3 anterior, 3 posterior (each trunk gives 1 anterior and 1 posterior division)
    • Cords (3):
      • Posterior Cord: formed from 3 posterior division
        • upper subscapular nerve (C5, 6): subscapularis
        • lower subscapular nerve (C5,6): subscapularis, teres major
        • thoracodorsal nerve (C6, 7, 8): latissmus dorsi
      • Lateral Cord: ant divisions of superior & middle trunks (C5, 6, 7)
        • lateral pectoral nerve (C5, 6, 7): pectoralis major, communication with medial pectoral nerve
      • Medial Cord: anterior division of inferior trunk (C8, T1) Branches (6) – 2 terminal branches from each cord
        • medial pectoral nerve (C8, T1): pierces pec minor; supplies pec minor and major
        • medial brachial cutaneous nerve (T1)
        • medial antebrachial cutaneous nerve (C8, T1)
        • Posterior cord:
          • axillary nerve (C5, 6): through quadrilateral space to teres minor, deltoid, major nerve supply to glenohumeral joint, superior lateral brachial cutaneous nerve
          • radial nerve (C5 – T1): runs with long head of triceps (triangular interval) into radial groove on posterior humerus; supplies elbow & forearm extensors, supinator; posterior brachial cutaneous, inferior lateral brachial cutaneous, posterior antebrachial cutaneous, superficial radial (post. radial hand)
        • Lateral cord:
          • lateral cord of median nerve (C5 – C7): joins medial cord anterior to axillary artery then travels with artery: wrist flexors (except FCU, ulnar ½ FDP), pronators, radial two lumbricals, OP, APB, superficial head FPB); sensory distribution in hand
          • musculocutaneous (C5, 6, 7): most superficial branch, pierces coracobrachialis (1.5-9 cm from origin) to supply biceps, coracobrachialis, brachialis, ends as lateral antebrachial cutaneous nerve
        • Medial cord:
          • medial cord of median nerve (C8, T1): see above
          • ulnar nerve (C8, T1): FCU, ½ FDP, adductor pollicus, deep head FPB, hypothenar, intrinics (except radial 2 lumbricals), sensory to hand
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