Brachial Plexus Assignment Help

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Brachial Plexus

It is a network of nerve fiber that begins from root of the neck, passing through the axilla and hence entering the upper arm. The anterior rami of cervical spinal nerve (C5, C6, C7 and C8) along with first thoracic spinal nerve (T1) forms the brachial plexus. Therefore to simplify the explanation of brachial plexus, it is categorized into five important parts: roots, divisions, trunks, cords and branches.

Roots

Root is the starting point of brachial plexus. The spinal nerves C5, C6, C7, C8 and T1 make the root.

The pairing of C5 and C6 results in formation of upper truck, C7 ascends to form the middle trunk and C8 and T1 therefore establishes to form the lower trunk. From level 5 arises, dorsal scapular nerve innervating the rhomboid muscles that in turn pull back the scapula. Further sub-clavian nerve patent in C5 and C6 and innervates the subclavius, finally the thoracic nerve arise from C5, C6 and C7 and therefore innervates serratus anterior. All these nerves leave the spinal cord through intervertebral foramina.

Trunk

The roots of the brachial plexus converges at the base of the neck, thus forming three types of truck:

  • Superior trunk or upper trunk (pairing of C5 and C6 roots)
  • Middle trunk (C7)
  • Inferior trunk (pairing of C8 and T1 roots)

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Divisions

The division of each trunk takes place within the posterior triangle of the neck named as anterior and posterior divisions, where one anterior division travel towards the front of the body and posterior division travel towards the back of the body.

Cords

Once the divisions leave the posterior triangle, they then pass into axilla which then merges to form three nerves, named as lateral cord, posterior cord and medial cord. The anterior division of the superior trunk and middle trunk forms the lateral cord, whereas posterior division of the superior trunk, middle truck and inferior trunk form the posterior cord. Finally medial cord is formed by the anterior division of the inferior trunk. These three cords in turn give rise to major branches of the brachial plexus.

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Major Branches

The lateral, posterior and medial cord give rise to five major braches in the axilla and proximal aspect of the upper limb and hence ascends in the upper limb providing innervation to the muscles and skin.

The Musculocutaneous nerve

Arising from lateral cord of the brachial plexus is musculocutaneous nerve. It contains fiber from C5, C6 and C7 spinal root. It then leaves from the axilla and pierces the coracobrachialis muscle. Then it passes down the arm innervating brachialis muscle and biceps brachii. It laterally emerges to the biceps tendon and carry on in the forearm as lateral cutaneous nerve. Musculocutaneous nerve displays sensory and motor functions.

  • Sensory function: It gives rise to lateral cutaneous nerve of the forearm that innervates the lateral aspect skin of the forearm.
  • Motor function: It innervates the muscles of the anterior compartment of the arm, the biceps, the brachii, the brachialis, and coracobrachialis.

The axillary nerve

Axillary nerve is the continuation of posterior cord of the brachial plexus containing fibers from C5 and C6 nerve root. It exists axilla posteriorly through quadrangular space supported by posterior circumflex humeral artery.

In the posterior region of Scapula, it is divided into two branches and then terminates. The two branches are termed as posterior terminal branch and anterior terminal branch.

  • Motor function: Both these branches provide motor innervation; posterior terminal branch to the Teres minor muscle, innervating skin over the lower part of the deltoid and anterior terminal branch to the deltoid muscle.
  • Sensory function: It is conveyed by posterior terminal branch.

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The median nerve

Derived from medial and lateral cord of the brachial plexus, the median nerve runs down the arm and then pass in the anterior compartments of the forearm through cubital fossa. It then travels between flexor digitorum profundus and flexor digitorum superficialis muscles. The two branches in the forearm are anterior interosseous nerve and palmar cutaneous nerve that supplies muscles deep in the anterior forearm and supplies to the skin of the lateral palm respectively. Likewise, it enters hands through carpel tunnel where it is divided into two branches named recurrent branch and palmar digital branch that innervates the thenar muscle and plamar surface along with fingertips of lateral three and half digit, two lumbrical muscles respectively.

  • Motor function: It innervates majority of muscles in the anterior forearm, along with some intrinsic hand muscles.
  • Sensory function: This nerve permits cutaneous innervation of a part of the hand, achieved through two branches; palmar cutaneous branch and palmar digital cutaneous branch.

Radial nerve

It is the continuation of posterior cord of brachial plexus having nerves from all five roots. This nerve arises the axilla and thus leaves posteriorly to the brachial artery and then enters down the arm in the swallow depression known as radial groove. At the posterior to the brachial artery, radial nerve supplies branches to middle head of the triceps brachii and inferiorly it gives branch to the lateral head of triceps brachii. It then enters the forearm through cubital fossa and lies anteriorly over the lateral epicondyle. In the forearm, the nerve ends dividing in two branches: deep branch and superficial branch.

  • Motor function: It innervates muscles located in arm and forearm.
  • Sensory function: It displays cutaneous innervation to the skin of the upper limb by the four branches of radial nerve namely lower lateral cutaneous nerve of arm, posterior cutaneous nerve of the arm, posterior cutaneous nerve of forearm and superficial branch of the radial nerve.

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Ulnar nerve

Ulnar nerve is the continuation of medial cord that has fibers from spinal roots C8 and T1. When it arise from brachial plexus, it then goes down the middle portion of the upper arm. Then it passes to the posterior to the medial epicondyle at the elbow, and enters the forearm. In the forearm, it is divided into two heads named as flexor carpi ulnaris, and travel alongside the ulna. Therefore the three branches that arise in the forearm are Muscular branch, palmar cutaneous branch and Dorsal cutaneous. It then travels to flexor retinaculum in the wrist and enters hand through ulnar canal. Then it terminates by giving rise to superficial and deep branches.

  • Motor function: It innervates muscle of anterior compartment of the forearm and the hand.
  • Sensory function: The three branches of ulnar nerve allows cutaneous innervation.

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