The 'brachial
plexus' is an arrangement of nerve fibres, running from the spine, specifically from above the fifth
cervical vertebra to underneath the first
thoracic vertebra (C5-T1). It proceeds through the neck, the
axilla (armpit region) and into the arm.
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 and an area of skin near the axilla innervated by the
intercostobrachialis nerve.
This funtion may be impaired by tumor growth of the Apical region of either Lung.
Therefore,
brachial plexus lesions can lead to severe functional impairment.
Anatomy
Path
One can remember the order of brachial plexus elements by way of the mnemonic, "'R'ead 'T'he 'D'amn 'C'adaver 'B'ook" - 'R'oots, 'T'runks, 'D'ivisions, 'C'ords, 'B'ranches
[1] or - Roots, Trunks, Divisions, Cords, Collateral/Pre-terminal Branches, and (Terminal) Branches.
★ The five 'roots' are the five
anterior rami of the
spinal nerves, after they have given off their segmental supply to the muscles of the
neck.
★ These roots merge to form three 'trunks':
★
★ "superior"
[1] or "upper" (C5-C6)
★
★ "middle"
[1] (C7)
★
★ "inferior"
[1] or "lower" (C8-T1)
★ Each trunk then splits in two, to form six 'divisions':
★
★ anterior division
[1] of the superior, middle, and inferior trunks
★
★ posterior division
[1] of the superior, middle, and inferior trunks
★ These six divisions will regroup to become the three 'cords'. The cords are named by their position in respect to the
axillary artery.
★
★ The ''
posterior cord'' is formed from the three posterior divisions of the trunks (C5-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 lower trunk (C8-T1)
★ The 'branches' are listed below. Most branch off of the cords, but a few branch (indicated in italics) directly off of earlier structures. The five in bold are considered "terminal branches".
Diagram
Specific branches
| 'From' | 'Nerve' | 'Roots' | 'Muscles' | 'Cutaneous' |
| roots | ''dorsal scapular nerve'' | C5 | rhomboid muscles and levator scapulae | - |
| roots | ''long thoracic nerve'' | C5, C6, C7 | serratus anterior | - |
| superior trunk | ''nerve to the subclavius'' | C5, C6 | subclavius muscle | - |
| superior trunk | ''suprascapular nerve'' | C5, C6 | supraspinatus and infraspinatus | - |
| lateral cord | lateral pectoral nerve | C5, C6, C7 | pectoralis major (by communicating with the medial pectoral nerve) | - |
| lateral cord | 'musculocutaneous nerve' | C5, C6, C7 | coracobrachialis, brachialis and biceps brachii | becomes the lateral cutaneous nerve of the forearm |
| lateral cord | 'lateral root of the median nerve' | C5, C6, C7 | fibres to the median nerve | - |
| posterior cord | upper subscapular nerve | C5, C6 | subscapularis (upper part) | - |
| posterior cord | thoracodorsal nerve | C6, C7, C8 | latissimus dorsi | - |
| posterior cord | lower subscapular nerve | C5, C6 | lower part of subscapularis and teres major | - |
| posterior cord | 'axillary nerve' | C5, C6 | ''anterior branch:'' deltoid and a small area of overlying skin ''posterior branch:'' teres minor and deltoid muscles | posterior branch becomes upper lateral cutaneous nerve of the arm |
| posterior cord | 'radial nerve' | C5, C6, C7, C8, T1 | triceps brachii, anconeus, the extensor muscles of the forearm, and brachioradialis | skin of the posterior arm as the posterior cutaneous nerve of the arm |
| medial cord | medial pectoral nerve | C8, T1 | pectoralis major and pectoralis minor | - |
| medial cord | 'medial root of the median nerve' | C8, T1 | fibres to the median nerve | portions of hand not served by ulnar or radial |
| medial cord | medial cutaneous nerve of the arm | C8, T1 | - | front and medial skin of the arm |
| medial cord | medial cutaneous nerve of the forearm | C8, T1 | - | medial skin of the forearm |
| medial cord | 'ulnar nerve' | C8, T1 | flexor carpi ulnaris, the medial 2 bellies of flexor digitorum profundus, most of the small muscles of the hand | the skin of the medial side of the hand and medial one and a half fingers on the palmar side and medial two and a half fingers on the dorsal side |
Additional images
See also
★
Brachial plexus lesion
★
Anesthesia of the brachial plexus
References
1.
2.
3.
4.
5.
6.
External links
★
★
Tutorial at anatome.ncl.ac.uk