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Syste matic Anatomy

Anatomy Department of WHU


Ⅲ. Brachial Plexus
(Ⅰ ) Position & formation

Position: posterosuperior
to subclavian artery.
root
Formation: the union of trunk C5
division
the anterior branches of C6
C5 - C8 & most part of C7

the anterior branch of C8


T1
T1.
roots
C4
C5
C6
divisions C7
trunks
C8

cords T1

roots trunks anterior division


posterior division
root
trunk C5
division
C6

C7

C8
T1

Trunk Superior Middle trunk Inferior


( C7 ramus )
Division trunk trunk
(anterior rami of C5 (central rami of C8
and C6) and T1 )
Anterior Lateral cord Medial cord
division (anterior division of the upper and (anterior division
middle trunk) of the lower trunk
)
Posterior Posterior cord
(Ⅱ) Branches of brachial plexus
1. Branches of supraclavicular group: most of them are short
muscular branches.
Dorsal scapular nerve levator scapulae and rhomboideus
Major long Suprascapular nerve supraspinatus and the infraspinatus
branches:
Long thoracic nerve serratus anterior
The damage of the long thoracic nerve
results in paralysis of the serratus
anterior and shows the symptom of
“winging of scapula”
2. Branches of infraclavicular group: Most of them are long
branches. They innervate the shoulder, the chest, the
brachia, the forearm and hands .
Major branches: median nerve, ulnar nerve, musculocutaneous
nerve, radial nerve, axillary nerve, thoracodorsal nerve,
lateral & medial pectoral nerves.
Median Nerve
Lateral cord
1. Roots
Medial cord
2. No branches in the arm.
3. Innervation: in the
forearm, distributes to root
trunk C5
most muscles in the division
flexor compartment of C6
the forearm except the
brachioradialis, the C7
flexor carpi ulnaris &
C8
the medial half of the
flexor digitorum T1
profundus.
3. Palmar cutaneous branch: innervates the skin of the thenar & central
part of the palm.
4. Recurrent branch: innervates the thenar muscles except the adductor
pollicis.
5. Common palmar digital nerves & proper palmar digital nerves:
control the 1st &
2nd lumbrical
muscles, innervate
the skin of the
palmar aspect of
the lateral 3 & ½
fingers, as well
the skin on the
dorsum of their
terminal
phalanges.
Ulnar Nerve
1. Arises from the medial cord of
the brachial plexus.
2. Has no branch in the arm.
3. In the forearm it innervates the
flexor carpi ulnaris & the medial
half of the flexor digitorum
profundus.
4. Dorsal branch: to the skin on the ulnar ½ of the dorsum &
the posterior surface of the ulnar 1 & ½ fingers.
5. Superficial palmar branch: to the skin of the hypothenar &
the anterior surface of the ulnar 1 and ½ fingers.
6. Deep palmar
branch: to the
hypothenar
muscles, the
adductor
pollicis, the 3rd
& the 4th
lumbricals, &
the interossei.
Skin of the hypothenar
Superficial branch
Skin of the anterior surface of the ulnar 1 & ½ fingers
Palmar
branches Hypothenar muscles
Adductor pollicis
Deep branch
Interossei
3rd & 4th lumbricals
Lateral antebrachial
Musculocuteneous nerve
cutaneous nerve
1. Arises from the lateral cord of the brachial plexus.
2. Its muscular branches
distribute to the
coracobrachialis, the biceps
brachii & brachialis.
3. The lateral antebrachial
cutaneous nerve distributes to
the skin on the lateral side of
the forearm.
Muscular Brachialis
Muscles in
Biceps brachii
Musculo- branch the arm
Coracobrachialis
cutaneous
n. Cutaneous Skin of the lateral side of
branch the forearm
lateral antebrachial cutaneous n.
Radial Nerve
1. Arises from the posterior cord of the brachial plexus.
2. Its branches in the arm:
1) Muscular branches: innervate the triceps brachii.
2) Cutaneous branches: supply the skin on the dorsum of
the arm.
3. At the level of the lateral epicondyle of the humerus, it is divided into deep &
superificial branches:
1) Deep branch: contributes to the brachioradialis & the posterior group muscles
of the forearm.
2) Superficial branch: contributes to the skin of the radial side of the dorsum of
the hand & of
the proximal
digits of the
radial 2 & ½
fingers.
Axillary Nerve
1. Arises from the posterior cord of
the brachial plexus. It passes
through the quadrangular space
with the posterior circumflex
humeral vessels.
2. Muscular branches:
supply the deltoid &
teres minor.
3. Cutaneous branch:
supplies the skin over
the deltoid.
Thoracodorsal nerve--- latissimus dorsi
Lateral pectoral nerve & medial pectoral nerve---
pectoralis minor and pectoralis major
Distribution of Cutaneous Nerves to Hand

Median
n.

Radial
Ulnar Ulnar
n.
n. n.
Median
n.

Radial
Ulnar Ulnar
n.
n. n.

The radial 2/3 skin of the palm.


Skin of the palmar part of the radial 3 & ½
Median n.
finger, as well as the skin of their dorsal part of
distal & middle phalanges.
Median
n.

Radial
Ulnar Ulnar
n.
n. n.

Skin of the hypothenar & the palmar surface of the


ulnar 1 & ½ fingers.
Ulnar n.
Skin on the ulnar ½ of the dorsum & the posterior
surface of the ulnar 1 & ½ fingers.
Median
n.

Radial
Ulnar Ulnar
n.
n. n.

Skin on the radial side of the dorsum of the hand


Radial n. Skin of the dorsum of the proximal digits of the
raidal 2 & ½ fingers
Highlights
The formation, position & distribution of 5 major
branches of the brachial plexus:
axillary nerve
musculocutaneous nerve
radial nerve
median nerve
ulnar nerve
Distribution of Cutaneous Nerves to Hand

Assignments

P466 Fig. Ⅵ-5-11