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COLLEGE OF ALLIED HEALTH
AND SCIENCES
ANATOMY MUSKULOSKELETAL
Cervical Plexus and Brachial Plexus
By : Hermizan Halihanafi...
The Spinal Nerves
31 pairs of spinal nerves (1st cervical above C1)
mixed nerves exiting at intervertebral foramen

Pro...
Branches of a Spinal Nerve
Spinal nerves: 8 cervical, 12

thoracic, 5 lumbar, 5 sacral
and 1 coccygeal.

Each has dorsal...
Notice the branching and merging of nerves in this

example of a plexus
Nerve Plexuses
Ventral rami branch and anastomose repeatedly to

form 5 nerve plexuses
cervical plexus
brachial plexus
...
Spinal Nerve Roots and Plexuses
Nerves Plexuses
The ventral (anterior) rami of spinal nerves, except for thoracic

nerves T2-T12, do not go directly to t...
Nerves Plexus
 The principal plexuses are:
1.

Cervical plexus

2.

Brachial plexus

3.

Lumbar plexus

4.

Sacral plexus...
Cervical Plexus
Formed by the anterior (ventral) rami of the cervical

nerves C1-C4 with contribution C5.
Supplies the s...
The Cervical Plexus
Terminal Branches
 Superficial branches (Sensory)
1. Lesser occipital (C2) – skin of scalp posterior and

superior to ear...
Lesser occipital
nerve C2 (ventral
rami)
Greater
occipital nerve
C2 (dorsal rami)

Greater
Auricular
nerve C2,C3
Transvers...
Terminal Branches
 Deep Branches (Motor)

Ansa cervicalis (superior root) – infrahyoid and
geniohyoid muscles of the neck...
Brachial Plexus
The anterior (ventral) rami of spinal nerves C5-C8 and T1

form the brachial plexus.
Extends inferiorly ...
Brachial Plexus
 Five important nerves arise from brachial plexus

are:
1.

Axillary nerve

2.

Musculocutaneous nerve

3...
Nerve Supply
The nerve that supplying the

structures in the arm are all
derivative from the brachial
plexus.
Brachial p...
Nerve Supply
Brachial plexus is formed by the ventral (anterior) rami

of the lower cervical nerves and the first thoraci...
Brachial Plexus
The anterior (ventral) rami of spinal nerves C5-C8 and T1

form the brachial plexus.
Extends inferiorly ...
Brachial Plexus
The brachial plexus provide the entire nerve supply of



the shoulder and upper limbs.
Five important ne...
Levels of Brachial Plexus
Roots

Real

Trunks

Trainers

Divisions

Drink

Cords

Cold

Branches

Beer
Roots
The five roots are the five anterior(ventral) rami of the

spinal nerves, after they have given off their segmental...
Trunk
Each trunk then splits in two, to form six divisions:
anterior division of the upper, middle and

lower trunks
po...
Division and Cords
These six divisions will regroup to become the three cords.

The cords are named by their position in ...
Spesific Branches
One can remember the specific branches of lateral,

posterior and medial cord using the mnemonic LML,
U...
Learn the Brachial Plexus
in Five Minutes or Less!!
Draw two headless arrows to the
right.
Add a headless arrow to the left
Add a “W “
Add an “X”
Add a “Y”. (Just a branch of the
“Y”is added.)
Label C5 to T1.
Label the major branches:
More complex diagramming
of the brachial plexus
includes the four “3s.”
The first “3”is the branches to C5, 6, and 7 which form
LTN = long thoracic nerve.
Next, each of the headless arrows has three nerves
attached to it.To the top headless arrow, add its “3.”
Label these “3”:DSN = dorsoscapular nerve; SS =
suprascapular nerve;LP = lateral pectoral nerve
Add the “3”to the middle headless arrow.
Label the second headless arrow “3”: SS = subscapular,
TD = thoracodorsal nerve.
Add the final “3”on the bottom headless arrow
*Label the last “3.”MP = medial pectoral,MBC = medial brachial
cutaneous, and MABC = medial antebrachial cutaneous.
*Remem...
Label roots, trunks, divisions, cords, terminal
branches.
Radiologists, neurosurgeons and thoracic
surgeons need to know the nerve to the
subclavius(SUB).
The complete brachial plexus diagram
From

Nerve

Root

Muscles

Roots

Dorsal scapular

C5

Rhomboid minor, major
and levator scapulae

Roots

Long thoracic

...
From

Nerve

Root

Muscles

Lateral cord

Lateral pectoral
nerve

C5. C6,
C7

Pectoralis major

Lateral cord

Musculocutan...
From

Nerve

Root

Muscles

Posterior cord

Thoracodorsal
nerve

C6, C7, C8

Latissimus dorsi

Posterior cord

Lower
subsc...
From

Nerve

Root

Muscles

Medial cord

Medial pectoral
nerve

C8, T1

Pectoralis major,
Pectoralis minor

Medial cord

M...
From

Nerve

Root

Muscles

Medial cord

Ulnar nerve

C8, T1

Flexor carpi ulnaris,
flexor digitorum
profundus, most of th...
Summary
1.





Branches from the roots
Nerves to the scalene and longus colli (C5, 6, 7, 8)
A branch to the phrenic n...
Summary
4. Branches from the cords of the plexus
i. Medial cord
 Medial pectoral nerve (C8, T1)
 Medial brachial cutaneo...
Summary
4. Branches from the cords of the plexus

ii. Posterior cord
 Upper subscapular nerve (C(4), 5, 6, (7))
 Thoraco...
Summary
4. Branches from the cords of the plexus

iii. Lateral cord
 Lateral pectoral nerve (C5, 6, 7)
 Musculocutaneous...
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  1. 1. COLLEGE OF ALLIED HEALTH AND SCIENCES ANATOMY MUSKULOSKELETAL Cervical Plexus and Brachial Plexus By : Hermizan Halihanafiah
  2. 2. The Spinal Nerves 31 pairs of spinal nerves (1st cervical above C1) mixed nerves exiting at intervertebral foramen Proximal branches Dorsal (posterior) root is sensory input to spinal cord Ventral (anterior) root is motor output of spinal cord Distal branches dorsal ramus supplies dorsal body muscle and skin ventral ramus to ventral skin and muscles and limbs meningeal branch to meninges, vertebrae and ligaments
  3. 3. Branches of a Spinal Nerve Spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. Each has dorsal and ventral ramus.
  4. 4. Notice the branching and merging of nerves in this example of a plexus
  5. 5. Nerve Plexuses Ventral rami branch and anastomose repeatedly to form 5 nerve plexuses cervical plexus brachial plexus Lumbar plexus Sacral plexus Coccygeal plexus
  6. 6. Spinal Nerve Roots and Plexuses
  7. 7. Nerves Plexuses The ventral (anterior) rami of spinal nerves, except for thoracic nerves T2-T12, do not go directly to the body structures they supply. They form networks on the both the left and right sides of the body by joining with various numbers of axons from anterior rami of adjacent nerves. Ventral rami branch and anastomose repeatedly to form 5 nerve plexuses
  8. 8. Nerves Plexus  The principal plexuses are: 1. Cervical plexus 2. Brachial plexus 3. Lumbar plexus 4. Sacral plexus 5. Cocygeal plexus
  9. 9. Cervical Plexus Formed by the anterior (ventral) rami of the cervical nerves C1-C4 with contribution C5. Supplies the skin and muscles of the head, neck and superior part of the shoulders and chest. Phrenic nerves arise from the cervical, innervate for the diaphragm muscles.
  10. 10. The Cervical Plexus
  11. 11. Terminal Branches  Superficial branches (Sensory) 1. Lesser occipital (C2) – skin of scalp posterior and superior to ear. 2. Great auricular (C2-C3) – skin anterior, inferior, and over ear and over parotid gland. 3. Transverse cervical (C2-C3) – skin over anterior aspect of neck. 4. Supraclavicular (C3-C4) – skin over superior portion of chest and shoulder.
  12. 12. Lesser occipital nerve C2 (ventral rami) Greater occipital nerve C2 (dorsal rami) Greater Auricular nerve C2,C3 Transverse Cervical nerve C2,C3 Supraclavicular nerve C2, C3
  13. 13. Terminal Branches  Deep Branches (Motor) Ansa cervicalis (superior root) – infrahyoid and geniohyoid muscles of the neck. 2. Ansa cervicalis (inferior root) – infrahyoid muscles of neck. 3. Phrenic nerve – diaphragm 4. Segmental branches – prevertebral muscles of the neck, levator scapulae and middle fiber of scalene. 1.
  14. 14. Brachial Plexus The anterior (ventral) rami of spinal nerves C5-C8 and T1 form the brachial plexus. Extends inferiorly and laterally on either side of the last four cervical and first thoracic vertebrae through intervetebral foramen. Passes above the first rib posterior to the clavicle and then enter the axilla (cervicoaxillary canal). The brachial plexus provide the entire nerve supply of the shoulder and upper limbs.
  15. 15. Brachial Plexus  Five important nerves arise from brachial plexus are: 1. Axillary nerve 2. Musculocutaneous nerve 3. Radial nerve 4. Median nerve 5. Ulnar nerve
  16. 16. Nerve Supply The nerve that supplying the structures in the arm are all derivative from the brachial plexus. Brachial plexus is a complex of intermingling nerves that originate from the neck (cervical and thoracic origin)
  17. 17. Nerve Supply Brachial plexus is formed by the ventral (anterior) rami of the lower cervical nerves and the first thoracic nerves. (C5, C6, C7, C8, T1) Occasionally, there maybe a contribution from C4 or T2 or both.
  18. 18. Brachial Plexus The anterior (ventral) rami of spinal nerves C5-C8 and T1 form the brachial plexus. Extends inferiorly and laterally on either side of the last four cervical and first thoracic vertebrae. Passes above the first rib posterior to the clavicle and then enter the axilla (passes through cervicoaxillary canal).
  19. 19. Brachial Plexus The brachial plexus provide the entire nerve supply of  the shoulder and upper limbs. Five important nerves arise from brachial plexus are:  1. Axillary nerve 2. Musculocutaneous nerve 3. Radial nerve 4. Median nerve 5. Ulnar nerve
  20. 20. Levels of Brachial Plexus Roots Real Trunks Trainers Divisions Drink Cords Cold Branches Beer
  21. 21. Roots The five roots are the five anterior(ventral) 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" or "upper" (C5-C6) "middle"(C7) "inferior" or "lower" (C8-T1)
  22. 22. Trunk Each trunk then splits in two, to form six divisions: anterior division of the upper, middle and lower trunks posterior division of the upper, middle, and lower trunks
  23. 23. Division and Cords 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 anterior division of the lower trunk (C8-T1)
  24. 24. Spesific Branches One can remember the specific branches of lateral, posterior and medial cord using the mnemonic LML, ULNAR , M4U respectively. LML - lateral pectoral nerve , musculocutaneous nerve , lateral root of the median nerve. ULNAR - upper subscapular nerve , lower subscapular nerve , nerve to latissmus dorsi (thoracodorsal nerve) , axillary nerve , radial nerve. M4U - medial pectoral nerve , medial root of the median nerve , medial cutaneous nerve of the arm , medial cutaneous nerve of the forearm , ulnar nerve.
  25. 25. Learn the Brachial Plexus in Five Minutes or Less!!
  26. 26. Draw two headless arrows to the right.
  27. 27. Add a headless arrow to the left
  28. 28. Add a “W “
  29. 29. Add an “X”
  30. 30. Add a “Y”. (Just a branch of the “Y”is added.)
  31. 31. Label C5 to T1.
  32. 32. Label the major branches:
  33. 33. More complex diagramming of the brachial plexus includes the four “3s.”
  34. 34. The first “3”is the branches to C5, 6, and 7 which form LTN = long thoracic nerve.
  35. 35. Next, each of the headless arrows has three nerves attached to it.To the top headless arrow, add its “3.”
  36. 36. Label these “3”:DSN = dorsoscapular nerve; SS = suprascapular nerve;LP = lateral pectoral nerve
  37. 37. Add the “3”to the middle headless arrow.
  38. 38. Label the second headless arrow “3”: SS = subscapular, TD = thoracodorsal nerve.
  39. 39. Add the final “3”on the bottom headless arrow
  40. 40. *Label the last “3.”MP = medial pectoral,MBC = medial brachial cutaneous, and MABC = medial antebrachial cutaneous. *Remember: the brachial cutaneous goes to the brachium or arm, and the MABC goes to the antebrachium or forearm.
  41. 41. Label roots, trunks, divisions, cords, terminal branches.
  42. 42. Radiologists, neurosurgeons and thoracic surgeons need to know the nerve to the subclavius(SUB).
  43. 43. The complete brachial plexus diagram
  44. 44. From Nerve Root Muscles Roots Dorsal scapular C5 Rhomboid minor, major and levator scapulae Roots Long thoracic C5, C6, C7 Serratus anterior Superior trunk Subclavian C5, C6 Subclavius Superior trunk Suprascapular C6, C6 Supraspinatus, infraspinatus
  45. 45. From Nerve Root Muscles Lateral cord Lateral pectoral nerve C5. C6, C7 Pectoralis major Lateral cord Musculocutaneous nerve C5. C6, C7 Coracobrachialis, brachialis, biceps brachii Lateral cord Lateral root of the median nerve C5. C6, C7 Fibers to the median nerve Posterior cord Upper subcsapular nerve C5, C6 Subscapularis
  46. 46. From Nerve Root Muscles Posterior cord Thoracodorsal nerve C6, C7, C8 Latissimus dorsi Posterior cord Lower subscapular C5, C6 Subscapularis Posterior cord Axillary nerve C5, C6 Anterior branch: Deltoid Posterior branch: Teres minor Posterior cord Radial nerve C5-C8, T1 Triceps brachii, supinator, anconeus, extensor muscles move the hand, brachioradialis
  47. 47. From Nerve Root Muscles Medial cord Medial pectoral nerve C8, T1 Pectoralis major, Pectoralis minor Medial cord Medial root of median nerve C8, T1 Fibers to the median nerve Medial cord Medial cutaneous nerve of the arm (medial brachial cutaneous) C8, T1 Skin of medial and posterior aspect of distal third of arm Medial cord Medial cutaneous nerve of the forearm (medial antebrachial cutaneous) C8, T1 Skin of medial and posterior aspects of forearm
  48. 48. From Nerve Root Muscles Medial cord Ulnar nerve C8, T1 Flexor carpi ulnaris, flexor digitorum profundus, most of the small muscles of the hand
  49. 49. Summary 1.     Branches from the roots Nerves to the scalene and longus colli (C5, 6, 7, 8) A branch to the phrenic nerve (C5) Dorsal scapular nerve (C5) Long thorasic nerve (C5, 6, 7) 2. Branches from the trunks  Nerve to subclavius / subclavian nerve (C(4), 5, 6)  Suprascapular nerve (C(4), 5, 6) 3. There are no nerves arising from the divisions
  50. 50. Summary 4. Branches from the cords of the plexus i. Medial cord  Medial pectoral nerve (C8, T1)  Medial brachial cutaneous nerve (T1)  Medial antebrachial cutaneous nerve (C8, T1)  Ulnar nerve (C(7), 8, T1)  Medial part of the median nerve (C8, T1)
  51. 51. Summary 4. Branches from the cords of the plexus ii. Posterior cord  Upper subscapular nerve (C(4), 5, 6, (7))  Thoracodorsal nerve (C(5), 7. 8)  Lower subscapular nerve (C5, 6)  Axillary nerve (C5, 6)  Radial nerve (C5, 6)
  52. 52. Summary 4. Branches from the cords of the plexus iii. Lateral cord  Lateral pectoral nerve (C5, 6, 7)  Musculocutaneous nerve (C5, 6, 7)  Lateral part of the median nerve (C(5), 6, 7))
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