1. Brachial Plexus
D.Rania Gabr
D.Sama-ul-Haque
D.Elsherbiny

2. Objectives Describe the brachial plexus
Make a list of contributing spinal nerves.
Discuss the general arrangement of this plexus.
Locate the plexus in the axilla and note important relations to blood vessels.
Make a list of the terminal main branches of brachial plexus.

3. Location of Brachial plexus

4. Brachial Plexus Def: nerve supply of upper limb.
Formation: It is formed by the union of the anterior Rami of the C 5th, 6th, 7th & 8th and T1 spinal nerve.
Roots…….trunks……division……cords…..branches
Site:
Roots & Trunks: in the posterior∆
Divisions: behind the clavicle (in cervico-axillary canal).
Cords & Branches: in the axilla

5. N e c k
C l a v i c l e
A x i l l a
R o o t s
T r u n k s
D i v i s i o n s
C o r d s
B r a n c h e s
C 5 A
upper
lateral 3 P
C 6
C 7
middle
posterior 5
C 8
lower 5
T 1
medial

8. Brachial Plexus Roots : C5,6,7,8 and T1. Trunk:
Upper trunk: union of C5.6
Middle trunk: C7.
Lower trunk : union of C8 and T1.
Division; each trunk divides into anterior and posterior.
Cords;
Lateral cord: union of anterior division of upper and middle trunk.
Medial cord: anterior division of lower trunk.
Posterior cord: union of posterior division of upper, middle and lower trunk.

10. Branches Brachial Plexus
(A) From Roots:
1. C5: Nerve to rhomboids (dorsal scapular nerve).
2. C5,6 &7: Long thoracic nerve
(B) From Trunks (upper trunk):
Nerve to subclavius
Suprascapular nerve

11. (C)Branches from the cords: Lateral Cord
(2LM)
.Lateral pectoral n
.Lateral root to median n
.Musculocutaneous n C5 C6 C7 C8 T1
Medial cord
(4MU)
.Medial pectoral n.
.Medial root to median n.
.Medial cutaneous n of arm.
.Medial cutaneous n of forearm.
.Ulnar n.
Posterior Cord
(ULTRA)
.Upper subscapular n
.Lower subscapular n
.Thoracodorsal n
.Radial n
.Axillary n

12. Lateral cord-3 Medial cord-5 Posterior cord-5
Lateral pectoral nerve.
Medial pectoral nerve.
Axillary nerve.
Musculocutaneous nerve.
Ulnar nerve.
Radial nerve.
Median nerve (lateral root).
Median nerve (medial root).
Upper & lower subscapular nerves.
Medial cutaneous nerve of arm & forearm.
Thoracodorsal or N. to latissimus dorsi.

13. Relations of Brachial plexus

14. Relations of brachial plexus
Posterior
Posterior
cord
Lateral
cord
Axillary
artery
Medial
cord
Lateral
Medial
Axillary vein
Anterior

15. Brachial Plexus Injuries
Nerve injury is manifested by:
1. Loss of sensation: in the area of cutaneous distribution.
2. Paralysis of voluntary muscles supplied.
3. Wasting of paralyzed muscles.

16. Lesions of the upper trunk C5,6
ERB'S paralysis
Cause: Birth injury.
The most commonly involved nerves:suprascapular nerve, musculocutaneous, and axillary nerve:
Muscles atrophy:
a. Muscles of shoulder.
b. Flexors of elbow.
c. Extensors of finger.

17. Policeman (waiter) tips paralysis
a. Adduction of the arm.
b. Extension of the elbow.
c. Pronation of the forearm.
d. Flexion of the fingers.

18. Falling on Shoulder

20. Excessive Stretching

22. Direct Blow

24. Lesions of the lower trunk (C8,T1) Klumpke paralysis or Palsy
Cause: Cervical rib (compression of the lower trunk and subclavian artery).
Deformity: Flail (claw) hand.
Muscles atrophy: All the intrinsic muscles of the hand.

26. Baby’s upper limb is pulled excessively during delivery

27. Claw Hand