Brachial Plexus Anatomy

• The plexus is responsible for the motor innervations to all of the muscles of the upper limb with the
exception of the trapezius and levator scapula
• It supplies all of the cutaneous innervations of the upper limb with the exception of the area of the axilla
(armpit) (supplied by the intercostobrachial nerve), an area just above the point of the shoulder (supplied
by supraclavicular nerves) and the dorsal scapular area which is supplied by cutaneous branches of
dorsal rami.
• Brachial plexus is a somatic nerve plexus formed by intercommunications among the ventral rami of the
lower four cervical nerves (C 5 - C 8) and the first thoracic nerve (T 1).
• Communicates with the sympathetic trunk by gray rami communicates that join all the roots of the
plexus and are derived from the middle and inferior cervical sympathetic ganglia and the first thoracic
sympathetic ganglion.

1. The brachial plexus consists of successively:

a. ventral rami & trunks - in the neck
b. divisions – usually posterior (deep) to the clavicle
c. cords & branches – in the axilla
2. Prefixed & Postfixed Brachial Plexus
a. Prefixed: Occurs when the C4 ventral ramus contributes to the brachial plexus; Contributions
from the plexus usually come from C4-C8
b. Postfixed: Occurs when the T2 ventral ramus contributes to the brachial plexus; Contributions to
the plexus usually come from C6-T2
3. Segments of the brachial plexus (Mnemonic: Robert Taylor Drinks Cold Beer=Roots, Trunks, Divisions,
Cords, Branches )
a. Roots: The ventral rami of the spinal nerves C5-T1 are referred to as the roots of the plexus
b. Trunks: Shortly after emerging from the intervertebral foramina, these 5 roots unite to form three
trunks.
i. The ventral rami of C5 & C6 unite to form the Upper Trunk.
ii.The ventral ramus of C 7 continues as the Middle Trunk.
iii.The ventral rami of C 8 & T 1 unite to form the Lower Trunk
c. Divisions: Each trunk splits into an anterior division and a posterior division.
i. The anterior divisions usually supply flexor muscles
ii.The posterior divisions usually supply extensor muscles
d. Cords:
i. The anterior divisions of the upper and middle trunks unite to form the lateral cord.
ii.The anterior division of the lower trunk forms the medial cord.
iii.All 3 posterior divisions from each of the 3 cords all unite to form the posterior cord.
iv.The cords are named according to their position relative to the axillary artery.
e. Branches:
i. Musculocutaneous:
1. Derived from the lateral cord
2. Runs superficially (near the skin) down the front of the arm.
3. Muscle innervations = C5-7
4. Supplies the muscles which flex (bend) the arm at the elbow joint
5. Damage = weak flexion of elbow ( Bicep + Brachialis)
6. Sensory innervations = from the lateral (radial) side of the forearm
7. Damage = paraesthesia to lateral forearm