The Brachial Plexus is a network of nerve fibers that run from the spine, passing through the cervico-axillary canal to reach axilla. It is formed by the ventral rami of the lower four cervical and first thoracic nerve roots (C5-C8, T1).

1.  Topic :- Brachial Plexus with Applied aspects
submited by:- mittal lohar
1 year {bhms}
Submitted To
Dr. NAZIMA PRAVEEN
Submitted By
Dr. MITTAL LOHAR
BHMS 1ST YEAR

2.  PLEXUS- IS A NETWORK OF NERVES
 BRACHIAL PLEXUS-
 FOUND IN THE NECK AND AXILLA
 FORMED BY VENTRAL RAMI OF C5-
C8 AND T1 ( THERE MAY BE
CONTRIBUTIONS FROM C4, T2)
 GIVES RISE TO NERVES THAT SUPPLY
THE UPPER LIMB
 FORMATION
 ROOTS- C5-C8 AND T1 ( VENTRAL
RAMI)
 TRUNKS-UPPER , MIDDLE, LOWER
 DIVISONS-ANTERIOR/POSTERIOR
 CORDS-MEDIAL/LATERAL/POSTERIOR
BRANCHES
 ROOTS FORMATION OF TRUNKS
 C5
 C6
 C7
 C8
 T1
UPPER
MIDDLE
LOWER
FORMED IN
THE NECK

3. BRACHIAL PLEXUS

5.  Ventral rami of C5 – T1: Exit neck between
scalenus anterior and scalenus medius
muscles.
• Direct branches from rami: Dorsal scapular
nerve C5 To rhomboid muscles.
• Long thoracic nerve C5-7 To serratus
anterior muscle.

6.  TRUNKS DIVISIONS CORDS
 UPPER TRUNK
 MIDDLE TRUNK
 LOWER TRUNK
PINK-
ANTERIOR
DIVISION
BLUE -
POSTERIOR
DIVISION
LATERAL CORD-ANTERIOR
DIVISIONS OF UPPER AND
MIDDLE TRUNK
POSTERIOR CORD-
POSTERIOR DIVISIONS OF ALL
TRUNKS
MEDIAL CORD-ANTERIOR
DIVISION OF LOWER TRUNK
CORDS ARE NAMED
ACCORDING TO THEIR
RELATIVE POSITIONS TO THE
AXILLARY ARTERY

7.  Formed by ventral rami.
 Located superior to clavicle above and behind
subclavian artery.
 Superior (upper)
From C5 and C6 ventral rami
 Middle:
From C7 ventral ramus
 Inferior (lower):
From C8 and T1 ventral rami

8.  Direct branches from trunks:
From Superior Trunk:
Suprascapular nerve
C5,C6 To supraspinatus
and infraspinatus muscle ,
Nerve to subclavius

9.  Anterior divisions:
Carry fibers from trunks to anterior
compartments of upper extremity.
Form lateral and medial cords
 Posterior Divisions:
Carry fibers from trunks to posterior
compartments of upper extremity.
Form posterior cord.

10.  Formed from divisions.
 Accompany axillary artery.
Named for relationship to artery.
 Lateral:
From anterior divisions of upper and
middle trunks.
 Posterior:
From posterior divisions of all trunks.
 Medial:
From anterior divisions of lower trunk.

11.  Direct branches:
Lateral pectoral nerve:
C5-7
To clavicular head of pectoralis major muscle
 Terminal nerves:
Musculocutaneous:
C5-7
Lateral root of median nerve:
C5-7

12.  Medial pectoral nerve:
C8-T1
To sternal head of pectoralis major
muscle and pectoralis minor muscle.
 Medial cutaneous nerve to arm (brachium)
 Medial cutaneous nerve to forearm
(antebrachium)

13.  Ulnar nerve
C8-T1
 Medial root of median nerve
C8-T1

14.  Upper subscapular nerve: C5-6
To subscapularis muscle
 Thoracodorsal nerve: C6-7
To latissimus dorsi muscle
 Lower subscapular nerve: C5-6
To subscapularis and teres major
muscles

15.  Axillary nerve:C5-6
Motor : To deltoid and teres minor muscles.
Sensory : Skin on arm over deltoid muscle:
Upper lateral cutaneous nerve
 Radial nerve:C5-T1
Motor : Posterior compartments of arm and
forearm.Brachioradialis muscle
Sensory : Back of arm, forearm, hand

16.  Mechanism of injury
 High velocity injury - stretch injury
 Low impact injury - stretch injury
 Lacerations

17.  If the injury was sustained due to a high
velocity accident e.g. a motorcycle RTA, then
the likelihood of a more serious pathology is
much greater than someone who has
sustained an injury from a fall. Patients
involved in high velocity accidents are also
more
likely to sustain other injuries e.g. Head
injuries, spinal and upper limb fractures and
vascular damage.

18.  Clinical factors indicating a relatively mild
lesion:
• Low impact
• Incomplete lesion
• No pain
• Tinel’s sign
• Absent Horner’s sign

19.  Clinical factors indicating a more serious
lesion:
• High impact injury
• Complete lesion
• Burning or shooting pains present since
the time of injury
 Horner’s sign (ptosis or drooping of the
eyelid with dilation of the pupil)

20. The damage to the brachial plexus nerves can
be classified into four different grades:
1. Pre-ganglionic tear.................Nerve root
avulsion
2. Post-ganglionic tear...............Neurotmesis
3. Severe lesion in-continuity.....Axonotmesis
4. Mild lesion in-continuity........Neurapraxia
5. Nerve Injury-
•INJURY TO MEDIAN NERVE-” APE HAND”
•INJURY TO ULNAR NERVE-” CLAW HAND”
INJURY TO RADIAL NERVE- “ WRIST DROP”

21.  Adult brachial plexus injuries fall into two
categories:

1. Supraclavicular injuries...........Nerves
damaged above the clavicle

2. Infraclavicular injuries.............Nerves
damaged below the clavicle

It is possible for nerves to be injured both
above and below the clavicle

22.  supraclavicular injury occur and can be subdivided
into three
groups:
1. Upper plexus C5,6 (+/-c7and +/-C8) If C7 and
C8 are involved the roots are sometimes
avulsed. There is less likelihood that the roots of
C5 and C6 will be avulsed.
 2. Total plexus - there is damage to all nerve roots.
C5, C6 may have post ganglionic
ruptures with the roots of C8 and T1 avulsed.
 3. Lower plexus - the roots of C8 and TI are
avulsed but C5 and C6 are working
normally

23. THANK YOU