BRACHIAL PLEXUS

WITH APPLIED ANATOMY

SUBTOPICS:
1. What is brachial plexus? What are its components.
2. Minor Branches of Brachial Plexus
3. Musculocutaneous nerve
4. Axillary nerve
5. Radial Nerve
6. Median Nerve
7. Ulnar Nerve
8. Erb’s Paralysis
9. Klumpke’s Paralysis
Topic : Introduction to Brachial Plexus

Moderator : Dr. Baneswar Baro

HOD : Prof. (Dr.) Ritu Saloi

Presented By : Anurag Roy

Roll no. 15
What is Brachial Plexus?
The Brachial plexus is
the plexus of nerves
formed by the
anterior(ventral) rami of
lower four cervical and the
first thoracic (i.e. C5-C8,
and T1) Spinal nerves with
little contribution from the
C4 to T2 Spinal nerves.
Pre-fixed Brachial Plexus
If the contribution from C4 is large and that from T2
is absent.
Post-fixed Brachial Plexus
If the contribution From T2 is large and that from C4
is absent.
Components of Brachial Plexus
•Roots

•Trunks

•Divisions

•Cords

•Branches
Topic : Minor branches Brachial Plexus

Moderator : Dr. Baneswar Baro

HOD : Prof. (Dr.) Ritu Saloi

Presented By : Vinayak Roy

Roll no. 95
 Minor branches of brachial plexus
•Long thoracic nerve,
•Dorsal Scapular nerve,
•Branch to Phrenic nerve,
•Suprascapular nerve,
•Nerve to subclavius
• Lateral pectoral nerve,
•Medial pectoral nerve,
•Medial cutaneous nerve of
arm and forearm
•Upper and lower subscapular
nerve,
•Thoracodorsal nerve
•Lateral and Medial root of
median nerve
 Branches arises from the roots of brachial plexus

 Long Thoracic Nerve:

(Root C5-C7): The long
thoracic nerve is
the motor nerve to
the serratus anterior
muscle, which functions
to pull the scapula
forward around the
thorax, allowing for
anteversion of the arm,
and to lift the ribs,
assisting in respiration.
 Branches of roots of brachial plexus
Dorsal Scapular Nerve:
(Root- C5):The dorsal scapular nerve is a motor nerve that provides
innervation to the rhomboid major, rhomboid minor and levator
scapulae muscles. Collectively, these muscles function to elevate and
retract the scapula.
 Branches of roots of brachial plexus
• Branch to Phrenic Nerve:
(Root- C4): The phrenic nerve is
a nerve that runs from the spinal
cord to the diaphragm, the
muscle that separates the chest
from the abdomen. It's a vital
nerve for breathing, as it
controls the diaphragm's
contraction and relaxation.
 Branches of Trunk of brachial plexus
• Suprascapular Nerve :
(Root- C5,C6): The
suprascapular nerve is a
branch from the upper trunk
of the brachial plexus; it
innervates the infraspinatus
and the supraspinatus
muscles. It originates in the
posterior triangle of the neck,
where it runs to the upper
part of the scapula downward
and laterally parallel to the
belly of the omohyoid muscle.
 Branches of Trunk of brachial plexus
• Nerve to Subclavius: (Root- C5,C6): The nerve to the subclavius, also known as the
subclavian nerve, is a small branch of the brachial plexus that innervates the
subclavius muscle which protects the underlying brachial plexus and subclavian
vessels from a broken clavicle—the most frequently broken long bone.
 Minor Branches of Lateral Cord

• Lateral Pectoral Nerve:

(Root- C5-C7):The lateral
pectoral nerve is a motor
nerve that supplies the
pectoralis major muscle
and, to a lesser extent, the
pectoralis minor muscle
 Minor branches of Medial cord
• Medial Pectoral Nerve:
(Root- C8,T1): The medial
pectoral nerve, also
known as the medial
anterior thoracic nerve, is
a motor nerve that
supplies the pectoralis
minor and pectoralis
major muscles.
 Minor branches of Medial cord

• Medial cutaneous nerve of arm:

(Root C8-T1): The medial
cutaneous nerve of the arm, also
known as the lesser internal
cutaneous nerve of arm, is a
branch of the medial cord of the
brachial plexus and supplies the
skin of the medial side of the arm
as far distal as the medial
epicondyle.
 Minor branches of Medial cord
• Medial cutaneous
nerve of forearm:
(Root C8-T1): The
medial cutaneous
nerve of the forearm,
also known as the
medial antebrachial
cutaneous nerve, is a
sensory nerve that
supplies the skin on
the medial forearm
and olecranon.
 Minor branches of Posterior cord

• Upper Subscapular
Nerve: (Root- C5-C6): It
innervates the superior
portion of the
subscapularis muscle
which is attached to the
subscapular fossa in the
scapula and is
responsible for rotation
of the shoulder.
 Minor branches of Posterior cord
• Lower Subscapular Nerve:
(Root- C5-C6): The lower
subscapular nerve contains two
branches. One branch inserts
into the lower portion of the
subscapularis muscle and the
other branch inserts into the
teres major.
 Minor branches of Posterior cord
• Thoracodorsal Nerve: (Root- C6-C8): It supplies the Latissimus Dorsi
muscle attached to the inferior angle of Scapula. This muscle is able
to pull the inferior angle of the scapula in various directions,
producing movements on the shoulder joint.
Topic : Musculocutaneous Nerve and
Axillary Nerve
Moderator : Dr. Baneswar Baro
HOD : Prof. (Dr.) Ritu Saloi

Presented By : Abdus Saieed

Roll no. 2
 Musculocutaneous Nerve
•Nerve of the front of the forearm
Origin: Lateral cord of brachial plexus in the
axilla.
Root Value: C5 – C7
Trick : MBBC , V II
Motor Branch
1. Biceps Brachi
2. Brachialis
3. Coracobrachialis
Cutaneous Branch
Lateral cutaneous nerve of the
Forearm
Course
It runs downward and
laterally, pierces the
coracobrachialis, which it
supplies, and then passes
between the biceps and
brachialis muscles .

It appears at the lateral

margin of the biceps tendon,
pierces the deep fascia just
above the elbow, and
descends over the lateral
aspect of the forearm as the
lateral cutaneous nerve of the
forearm.
•Musculocutaneous
innervations of arm is
purely motor while that
of forearm is purely
sensory.
 Axillary Nerve
Origin: Arises from posteror cord
of brachial plexus near the lower
border of the subscapularis.

Root Value : C5, C6

Trick: AK 56 Riffle, Admit
Musculocutaneous Branch
Deltoid
Teres minor
Cutaneous Branch
Posterior and lateral surface of
Deltoid.
Course
It runs backward on
subscapularies to pass
through the
quadrangular space
along with the
posterior circumflex
humoral artery .The
nerves gives a branch
to the shoulder joint
and then runs literally
to divide into the
anterior and posterior
divisions deep to
deltoid.
•The posterior branch supplies
teres minor and posterior part
of the deltoid. It then continues
over the posterior border of
the deltoid as upper lateral
cutaneous nerve of the arm
and supplies skin over the
lower half of the deltoid. The
nerve to teres minor possesses
a pseudo ganglion .

•The anterior branch continues

horizontally between the
deltoid and surgical neck of
the humerus with posterior
circumflex humeral vessel.
Topic : Radial Nerve

Moderator : Dr. Baneswar Baro

HOD : Prof. (Dr.) Ritu Saloi

Presented By : Hunmoni Urang

Roll no. 39
 Radial Nerve
Root value : C5 – C8, T1
All muscles of posterior forearm
Superficial muscles
•Brachioradialis
•Triceps brachii
•Extensor carpi radialis longus
•Extensor carpi radialis brevis
•Extensor Digitorum
•Extensor Digiti Minimi
•Extensor carpi ulnaris
•Anconeus
Deep Muscles
•Supinator
•Extensor pollicis longus
•Extensor pollicis brevis
•Abductor pollicis longus
•Extensor indicis
Cutaneous Branch
•Posterior surface of arm and forearm
•Lateral 2/3 of dorsum of hand lateral to
the axial line of ring finger.
Origin: It is a continuation of
posterior cord of brachial
plexus.
•It is the largest nerve of the
upper limb and largest branch of
brachial plexus
Course
It runs from the axilla
through the arm and into
the forearm where it splits
into two branches.
Radial nerve enters the
arm at the lower border of
the teres major.

It passes between the long

and medial head of triceps
to enter the lower
triangular space through
which it reaches the spiral
groove along the
profounda brachii artery.
 Wrist Drop
•Loss of extension of
wrist due to paralysis of
wrist extensors. This
causes wrist drop due
to unopposed action of
flexor muscles of the
forearm
•Saturday night palsy
•Spiral groove/ radial groove
Topic : Median Nerve and Ulnar Nerve

Moderator : Dr. Baneswar Baro

HOD : Prof. (Dr.) Ritu Saloi

Presented By : Nuing Limboo

Roll no. 67
 Median Nerve
Laborer’s Nerve, Eye of the hand
Origin : Arises from brachial plexus from two roots-
Lateral and Medial.
Root Value : C6 – C8, T1 (Sometimes also C5)
Trick: M61 Cannon
Forearm
All the flexor muscles of the forearm apart from
Flexor carpi ulnaris and
Medial half of flexor digitorum profundus
Hand
Trick : 1,2 LOAF
1,2 Lumbricals
Opponens Pollicis
Abductor Pollicis brevis
Flexor Pollicis brevis
 Motor Branch
Pronator Teres
Pronator Quadratus
Flexor carpi radialis
Palmaris longus
Flexor Digitorum Superficialis
Radial half of Flexor Digitorum Profundus
1,2 LOAF
Cutaneous nerve supply:
•Skin overlying thenar eminence is supplied by the
palmar cutaneous branch of the median nerve.
•Skin on the palmar aspect of the lateral 3½ finger is
supplied by the median nerve.
•Skin on the dorsal aspect of lateral 3½ finger is
supplied by the median nerve except the proximal
phalanges.
•Skin on the dorsal aspect of the hand and proximal
phalanges of lateral 33% finger is supplied by the
superficial branch of the radial nerve.
Clinical anatomy :
•Compression of the median nerve between the
two heads of pronator teres is known as Pronator
teres syndrome.
•Compression of the median nerve in the Carpal
tunnel is called Carpal Tunnel Syndrome.There is
paralysis of muscles supplied by the median
nerve in hand leading to Ape Thumb deformity &
Pointing Index Finger, Claw hand of index &
middle fingers.
•There is loss of sensation of skin on the palmar
aspect of the lateral 3½ fingers & dorsal aspect of
lateral 3% fingers except the proximal
phalanges.Sensations of skin overlying the thenar
eminence are intact as it is supplied by the
palmar cutaneous branch of the median nerve
(given before the Flexor Retinaculum)
•Median nerve is formed by the lateral root of the median nerve arising from the
lateral cord (C5, C6, C7) and the medial root of the median nerve arising from the
medial cord (C8, TI). Hence, the root value of the median nerve is C5-T1.
•The medial root is longer. It crosses the third part of axillary artery from medial to
lateral side & joins with the lateral root. Thus, the median nerve formed lies lateral
to the third part of the axillary artery.
•It crosses the brachial artery from lateral to the medial side in the middle of the
arm.
•In the cubital Fossa, the median nerve is the most medial content.It leaves the
cubital fossa by passing between the two heads of pronator teres muscle.
• Deep head of the pronator teres separates the median nerve from the ulnar artery.
•Sometimes, the median nerve can get compressed between two heads of pronator
teres which leads to pronator teres syndrome.
• After its exit from Pronator teres muscle it gives the Anterior Interosseous Nerve.
•In the Forearm, the median nerve lies an flexor digitorum profundus muscle and
below flexor digitorum superficialis.
•At the wrist, it lies between the tendons of flexor carpi radialis and palmaris
longus.a It enters the hand deep to flexor retinaculum through the carpal tunnel.
•Carpal tunnel syndrome
The median nerve is injured in the carpal
tunnel due to its compression and produces a
clinical condition called carpal tunnel
syndrome . The carpal tunnel is formed by
anterior cavity of carpus and flexor
retinaculum.

•In the capital fossa the median nerve lies

medial to the brachial artery and tendon of
biceps brachii.

•Median nerve enter the palm by passing

through carpal tunnel where it lies deep to
flexor retinaculum .
 Ulnar Nerve
Musician’s nerve
Origin: It arises from posterior cord of
brachial plexus.
Root Value : C7, C8, T1
Trick : LI (71)
Forearm
Flexor Carpi ulnaris
Medial half of flexor digitorum
profundus
Hand
The intrinsic muscles of
hand Except 1,2 LOAF
 Motor Branch
Abductor Pollicis
Ulnar half of flexor digitorum
profundus
Flexor Carpi Ulnaris
Opponens Digiti Minimi
Flexor Digiti Minimi
Abductor Digiti Minimi

Cutaneous Branch
Medial 1/3 of hand
Little finger
Medial ½ of ring finger
•Ulnar nerve arises from the medial cord. Its root value
is C7, C8, T1. C7 fibers arise from the lateral cord.
•It lies between the axillary artery and vein with medial
cutaneous nerve of the forearm above it.
•In the middle of the arm, the ulnar nerve pierces the
medial intermuscular septum along with superior ulnar
collateral artery.
•The nerve lies behind the Medial epicondyle of
humerus.It passes between two heads of flexor carpi
ulnaris to reach front of the forearm.
•In the forearm - ulnar nerve lies below the Flexor carpi
ulnaris & on flexor digitorum profundus. The ulnar
nerve passes below the Volar Carpel Ligament through
Guyons Tunnel, to enter the hand. In the hand ulnar
nerve is divided into a Superficial & Deep Branch.
•It enters the arm at the level of
insertion of choracobrachialis, where
it pierces the medial intermuscular
septum to enter the posterior
compartment of the arm and runs
downward to the back of the medial
epicondyle of the humerus .

•The nerve enters the forearm by

passing between the two head of
flexor carpi ulnaris.

•The ulnar nerve behind medial

epicondyle of humerus is termed
funny bone .

•The deep branch of the ulnar nerve is

purely motor and supplies all the
intrinsic muscle of the hand except the
muscle of thenar eminence and 1st
two lumbricals.
Cutaneous nerve supply:
•Skin overlying hypothenar eminence is supplied by the
palmar cutaneous branch of the ulnar nerve.
•Skin on the palmar aspect of the medial 1½ finger is supplied
by the superficial branch of the ulnar nerve.
•Skin on the dorsal aspect of the medial 1½ finger is supplied
by the superficial branch of the ulnar nerve except the
proximal phalanges.
•Skin on the dorsal aspect of the hand and proximal
phalanges of the medial 2½ Finger is supplied by the dorsal
cutaneous branch of the ulnar nerve.
Clinical anatomy:
•Ulnar nerve Compression of Ulnar nerve between two
heads of flexor carpi ulnaris is known as Cubital Tunnel
Syndrome.
•Lesion of Ulnar nerve in hand would lead to paralysis of
15 muscles (claw hand of last two digits) & loss of
sensations of the skin on palmar aspect of the medial 1½
fingers & dorsal aspect of the medial 1% finger except the
proximal phalanges.
•Skin overlying hypothenar eminence is spared as it is
supplied by palmar cutaneous branch of the ulnar nerve.
•Also, skin on the dorsal aspect of the hand and proximal
phalanges of the medial 2% Finger is spared as it is
supplied by the dorsal cutaneous branch of the ulnar
nerve.
Topic : Erb’s Paralysis

Moderator : Dr. Baneswar Baro

HOD : Prof. (Dr.) Ritu Saloi

Presented By : Puja Barman

Roll no. 73
 ERB’S PARALYSIS
Erbs paralysis , also known as ERB’s- D U C H E N N E is a form
of brachial plexus injury that affect the nerves supplying the
muscles of the upper trunk
 Site of Injury
ERB’S paralysis
occur due to
Upper Brachial
plexus injury.

ERB’S point
The region of the upper trunk of the
brachial plexus where six nerves
meet, any injury to this ERB’Spoint
causes ERB’Sparalysis
 Causes of Injury
If , Angle between Head and Shoulder is
excessively increased, due to any
reason.

May lead to overstretching of Brachial

plexus

May result upper Briachial plexus

injury
Causes of Injury
Causes of injury

• Birth injury/ Difficult

childbirth

• Fall on the shoulder

• During anaesthesia
 Nerve roots involved -C5 & C6 roots

Main Nerves involved :

1.Suprascapular Nerve (C5 , C6)

2. Musculocutaneous Nerve (C5,C6,C7)

3. Axillary nerve (C5 , C6)

 Suprascupular Nerve Axillary Nerve
(C5 , C6) (C5 , C6)

Muscles
Supraspinatus Infraspinatus Teres Minor Deltoid
paralysis

Lateral rotation of arm at shoulder

joint

Abductor of arm at shoulder joint

Patients is unable to abduct and laterally rotate his arm at shoulder

Disability joint

Deformity Arm is Adducted and Medially rotated at shoulder

joint
And
Position Arm ,hangs by the side.
of upper
limb
 Musculocutaneous Nerve Radial Nerve
(C5 , C6 , C7) (C5 , C6 , C7 , C8 , T1)

Muscles
paralysis Brachialis Biceps Brachii Supinator Brachioradialis

Supinator of forearm

Powerful flexor of forearm at elbow joint

Flexion and supination movement of forearm are

lost
Disability
Biceps and supinator jerks are
lost

Deformity
and
Position of Forearm is Extended and
upper limb Pronated
Conventional treatment methods
for ERB’S Palsy
Surgical
Non-surgical
 SURGICAL

NERVE MUSCLE
BOTOX
REPAIR REPAIR INJECTION
 NON-SURGICAL

EXCERCISE
PHYSIOLOGY RECREATION HYDROTHERAPY
THERAPY THERAPY
Topic : Klumpke’s Paralysis

Moderator : Dr. Baneswar Baro

HOD : Prof. (Dr.) Ritu Saloi

Presented By : Debasish Saikia

Roll no. 28
 Klumpke’s paralysis
(Lower Plexus Injury)
It is a form of brachial plexus injury that affect the
nerves supplying the muscles of the lower trunk .
Site of Injury: Lower trunk of
brachial plexus

Cause: Undue abduction of arm,

which may occur when falls on an
outstretched hand or as in birth
injury.
Nerves roots involved: Mainly T1
and Partly C8
Clinical Features:
•Claw Hand
•Horner’s Syndrome
 Claw Hand
Muscles Paralysed:
All the Intrinsic muscles of the hand (T1)
Ulnar flexors of the wrist and fingers(C8)

Deformity and Disability:

Hyperextension at the meta carpophalangeal
joints.
Flexion at the interphalangeal joints.
Loss of sensations along the medial border of the
forearm and hand.
 Horner’s Syndrome
• Horner syndrome is a rare
neurological syndrome that
affects your eye and the
surrounding area on one side
of your face .
• Injury to sympathetic fibres
to the head and neck that
leave the spinal cord
through nerve T1.
• Loss of ciliospinal reflex
• Ptosis
• Miosis
• Anhydrosis
• Enophtalmos(Entry of
eyeball to the orbit)