Brachial Plexus

By: Dr.Chaman Lal

B.S.PT, PPDPT, Dip. in sports Injuries, MPPS(PAK),
PG in Clinical Electroneurophysiology (AKUH),
Registered.EEGT (USA),
Member of ABRET, AANEM & ASET (USA).
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BRACHIAL PLEXUS

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 Vertebras & Spinal Nerves
Total 33 vertebras
Cervical =07
Thoracic =12
Lumber =05
Sacral =05
Coccygeal =04
Spinal nerves 31 pairs
Cervical =08
Thoracic =12
Lumber =05
Sacral =05
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• Flexion/Extension of the
cervical spine is at;
– Atlanto-occipital joint
• Rotation of the cervical
spine is at;
– Atlanto-axial joint

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 14/09/2010

Vertebral Foramen

Atlas (C1)

• Intervertebral foramen

Sacrum
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 Terms To Define?
Horns in Spinal Cords..?
• Ventral/Anterior Horn Ramus…?
• Lateral Horn • Ventral Ramus
• Dorsal/Posterior Horn • Dorsal Ramus
Root…?
• Ventral Root Efferent Nerve….?
• Dorsal Root
Spinal Nerve…? Afferent Nerve…?

Ganglion…?
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 “Horns” In The Spinal Cord
• In the spinal cord the gray matter is present inside
and white matter is towards outside while in brain
this distribution is vice versa.
• On cross section of the spinal cord gray matter in
spinal cord presents butterfly like structure form
which some projections like “Horns” are seen termed
as:
Ventral/Anterior Horn→ {Ventral/Anterior/Motor Root
Centre}
Lateral Horn →{Preganglionic Sympathetic Neurons; its
present only in T1-L2}
Dorsal/Posterior Horn→{Dorsal/Posterior/Sensory Root
Centre}
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 Terms To define….cont’d
• Root
• Ventral/Anterior/Motor/Efferent Root:
It arises from Ventral or Anterior horn
of the Spinal Cord and carries only motor fibers.
• Dorsal/Posterior/Sensory/Afferent Root:
It arises from Dorsal or Posterior horn
of the Spinal Cord and carries only sensory fibers.
Spinal Nerve:
• The dorsal and ventral roots, arising from each spinal
cord segment, fuse within the intervertebral foramen
to form a mixed spinal nerve.
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 Terms To define….cont’d
• Ganglion: Collection of the nerve cell bodies is called
“Ganglion” e.g., Dorsal Root Ganglion “DRG”, sympathetic
paravertebral ganglion.
• Ramus (Pl. rami)
The spinal nerve when exits from the vertebrae it divides
into two branches termed as;
1. Ventral/Anterior Primary Ramus
2. Dorsal/Posterior Primary Ramus
• Ventral/Anterior Ramus:
It is the ventral or anterior division of the
spinal nerve out side the vertebrae. It supplies to the skin,
muscles on anterior body & viscera etc.
• Dorsal/Posterior Ramus:
It is the dorsal or posterior division of the
spinal nerve out side the vertebrae. It supplies to the skin &
muscles of the back.
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• All plexus i.e., Cervical, Brachial & Lumbo-sacral are
formed by the fusion of Ventral or Anterior Primary
rami of the spinal nerves.
• Brachial Plexus are formed by anterior primary rami of
C5 , C6 , C7 , C8 , T1 spinal nerves.
• Now these are termed as Ventral/ Anterior Spinal Nerve
Roots.
• Brachial Plexus has the following relations to the
surrounding structures:
– The roots lie between the anterior and middle scalene
muscles.
– The trunks traverse the posterior triangle of the neck.
– The divisions lie behind the clavicle.
– The cords lie in the axilla, and are named according to
their relationship with the Axillary artery.
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 • Nerve Roots
ROOT
– C5,6,7,8,T1
• Trunks
– Upper
T
RUNK
– Middle
– Lower
DIVISIONS
• Divisions
– Anterior
CORDS – Posterior
• Cords
B
RANCHES – Lateral
– Medial
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– Posterior
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 Brachial Plexus…..cont’d
• Roots : These are constituted by the anterior
primary rami of spinal nerves C5 , C6 , C7 , C8 , T1 .

• Trunks :
o Upper Trunk: It is formed by the combination of
C5 & C6 spinal nerve roots.
o Middle Trunk: It is formed by the continuation of
the C7 spinal nerve root.
o Lower Trunk: It is formed by the combination of the
C8 & T1 spinal nerve roots.
The trunks traverse the posterior triangle of the
neck.
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 `

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 Brachial Plexus…..cont’d

• Divisions:
Now each trunk give rise to two divisions i.e.,
1. Anterior Division
2. Posterior Division
The divisions lie behind the clavicle.
• Cords:
o Lateral Cord: It is formed by the combination of Anterior
divisions of Upper & Middle Trunks.
o Medial Cord: It is formed by the continuation of anterior
division of Lower Trunk.
o Posterior Cord: It is formed by the combination of all three
posterior divisions of Upper , Middle & Lower Trunks.
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 Brachial Plexus…..cont’d

• The cords lie in the axilla, and are named according

to their relationship with the Axillary artery.
• Branches:
• Branches of the Roots:
1. Long Thoracic Nerve (C5 , C6 , C7 )
2. Dorsal Scapular Nerve (C5 )
• Branches of the Trunks:
1. Suprascapular Nerve (C5 , C6)
2. Nerve To Subclavius (C5 , C6)

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 Branches of Brachial Plexus…..cont’d

• Branches of the Cords:

Lateral Cord (C5 , C6 , C7 ) : It gives Three branches;
1. Lateral pectoral Nerve
2. Musculocutaneous Nerve
3. Lateral root of Median Nerve {2LM}
Medial Cord (C8 , T1): It gives Five branches;
1. Medial Pectoral Nerve
2. Medial Cutaneous Nerve of Arm
3. Medial Cut.N. of forearm (Medial Antibrachial Nerve)
4. Medial Root of Median Nerve
5. Ulnar Nerve {4MU}
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 Branches of Brachial Plexus…..cont’d

Posterior Cord (C5 , C6 , C7 , C8 , T1 ):

1. Upper Subscapular Nerve
2. Lower Subscapular Nerve
3. Thoracodorsal Nerve (Nerve To latissimus dorsi)
4. Axillary Nerve
5. Radial Nerve {2STAR}

Medial AnGbrachial→ Medial Cord

Lateral AnGbrachial→ ConGnuaGon of
Musculocutaneous Nerve → Lateral Cord
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 Main Terminal Branches

• Musculocutaneous Nerve
• Axillary Nerve
• Median Nerve
• Ulnar Nerve
• Radial Nerve

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 October 8, 2008
Karl Merk, the world's
first person to receive a
complete double arm
transplant.

Farmer Merk who received the

world's first complete double arm
transplant is recovering well and
able to perform some basic tasks. It
still could take up to two-years until
he re-learns how to use his hands.
Doctors spent 15 hours on July 25-26
grafting the donor arms onto the
body of 54-year-old Karl Merk, who
lost his own just below the shoulder
in a farm accident involving a
combine six years ago.
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First they exposed the muscle, nerves and blood vessels to be connected.
Before the bones of the donor could be cut, blood vessels in the teen’s arms
were filled with a cooled preservation solution. Both arms were then
removed exactly at the point matching Karl’s arm stumps.The bones were
joined, then arteries and veins to ensure blood circulation as quickly as
possible. The surgeons then attached the muscles and tendons, then the
nerves and finally the skin. There had been no sign that Karl’s immune system
was rejecting the foreign tissue and his scars were healing well.
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"The feeling is indescribable. Every day I gain more mobility," said Mr Merk as he showed
off the arms, which are being supported by a special "corset" while the healing continues.
Karl can already open a door and turn lights on and off.

http://www.telegraph.co.uk/news/worldnews/europe/germany/Worlds-
first-double-arm-transplant-patient-delighted.html
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References:
Snell's Text Book of Anatomy “Brachial Plexus” 23rd Ed.
Human Anatomy “Upper Limb& Thorax Anatomy”
Vol.I By: B.D Chaurasia.
“Anatomy & Physiology” By: Inderbir Singh,
JP Brothers Publication.
“ESSENCE” (A Review Book of Gross Anatomy)
6th Ed. Dow Promotion Cell Publication.
Electromyography & Neuromuscular Disorders” By David
C.Preston & Barbra E.Shapiro 2nd Ed.
www.telegraph.co.uk/news/worldnews/europe/germany/
Worlds-first-double-arm-transplant-patient-
delighted.html
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 “Success doesn’t lie in the Results”
“but in the Efforts”
“Being” the best is NOT so important
“Doing” the best is all that Matters…!
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