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π§ Brachial Plexus - The Complete, Easy Guide
The Golden Formula First
"Robert Taylor Drinks Cold Beer"
β Roots β Trunks β Divisions β Cords β Branches
This is the entire structure of the brachial plexus in 5 words.
STEP 1: THE ROOTS (C5, C6, C7, C8, T1)
Think of it as: "5 roots feed the arm"
The brachial plexus is formed by the anterior rami of spinal nerves C5 to T1.
Here's the simplest image to anchor this in your mind:
- Roots travel between the anterior scalene and middle scalene muscles
- They receive gray rami communicantes from the sympathetic trunk
STEP 2: TRUNKS (3 trunks) - "SUperMan Inspires"
| Trunk | Formed by | Mnemonic |
|---|
| Superior | C5 + C6 | Super heroes = 5+6 (like 5 fingers + 6th sense) |
| Middle | C7 alone | Middle = Monolone (one alone = C7) |
| Inferior | C8 + T1 | Inferior = the last two get together |
STEP 3: DIVISIONS (6 total) - The "No Man's Land"
- Each trunk splits into an Anterior and Posterior division
- 3 trunks Γ 2 = 6 divisions
- No nerves arise directly from divisions (this is a favourite exam point!)
- Anterior divisions β supply flexor (front) compartments
- Posterior divisions β supply extensor (back) compartments
STEP 4: CORDS (3 cords) - Named by position to axillary artery
Mnemonic: "LMP" = Lateral, Medial, Posterior
| Cord | Origin | Root values | Position |
|---|
| Lateral | Ant. div of Superior + Middle trunk | C5, C6, C7 | Lateral to axillary artery |
| Medial | Ant. div of Inferior trunk | C8, T1 | Medial to axillary artery |
| Posterior | ALL 3 posterior divisions | C5-T1 | Posterior to axillary artery |
Memory trick: The cords are named by their relation to the 2nd part of the axillary artery.
STEP 5: BRANCHES - The Complete Map
Here's the full schematic from Gray's Anatomy showing all branches:
Branches from ROOTS:
| Nerve | Root | Supplies |
|---|
| Dorsal scapular | C5 | Rhomboids (major + minor) |
| Long thoracic | C5, C6, C7 | Serratus anterior |
Mnemonic for long thoracic: "C5, 6, 7 keep the wing off heaven" - serratus anterior holds the scapula flat.
Branches from TRUNKS (Superior trunk only):
| Nerve | Supplies |
|---|
| Suprascapular | Supraspinatus + Infraspinatus |
| Nerve to subclavius | Subclavius |
Branches from CORDS:
Lateral Cord - "My Liver Must Be Lateral" β Musculocutaneous, Lateral pectoral, (half of) Median
| Nerve | Supplies |
|---|
| Musculocutaneous (C5-C7) | Biceps, brachialis, coracobrachialis + lateral forearm skin |
| Lateral pectoral (C5-C7) | Pectoralis major |
| Lateral root of Median | (joins medial root to form median nerve) |
Medial Cord - "MMMU" β Medial pectoral, Medial cutaneous of arm, Medial cutaneous of forearm, (medial root of) Median, Ulnar
| Nerve | Supplies |
|---|
| Medial pectoral (C8, T1) | Pec major + minor |
| Medial cutaneous nerve of arm (C8, T1) | Medial arm skin |
| Medial cutaneous nerve of forearm (C8, T1) | Medial forearm skin |
| Medial root of Median | Forms median nerve (with lateral root) |
| Ulnar (C7, C8, T1) | Intrinsic hand muscles, medial 1.5 fingers |
Posterior Cord - "START" β Superior subscapular, Thoracodorsal, Axillary, Radial, (Inferior subscapular)
| Nerve | Supplies |
|---|
| Superior subscapular | Subscapularis (upper part) |
| Thoracodorsal (C6-C8) | Latissimus dorsi |
| Axillary (C5, C6) | Deltoid + teres minor + skin over deltoid |
| Radial (C5-T1) | All posterior compartment muscles (extensor compartment) |
| Inferior subscapular | Subscapularis (lower) + teres major |
STEP 6: THE 5 TERMINAL BRANCHES - "My Aunt Raped My Uncle"
| Letter | Nerve | Cord of origin |
|---|
| M | Musculocutaneous | Lateral |
| A | Axillary | Posterior |
| R | Radial | Posterior |
| M | Median | Lateral + Medial (both roots) |
| U | Ulnar | Medial |
INJURIES - The 2 Big Ones (Always Exam Favourites)
1. ERB's PALSY (Upper brachial plexus injury - C5, C6)
Mechanism: Forceful widening of neck-shoulder angle (baby delivery traction, fall on shoulder)
Deformity: "Waiter's Tip Position"
- Arm: adducted, medially rotated (loss of deltoid + supraspinatus)
- Forearm: pronated + extended (loss of biceps + brachialis)
- Wrist: flexed
Affected movements: Abduction, lateral rotation, flexion, supination all lost
Root level: C5, C6 (superior trunk)
2. KLUMPKE'S PALSY (Lower brachial plexus injury - C8, T1)
Mechanism: Sudden upward pull of arm (grabbing a tree branch while falling)
Deformity: "Claw Hand"
- Loss of all intrinsic hand muscles (ulnar + median intrinsics)
- Hyperextension at MCPs, flexion at IPs
If T1 sympathetic fibers involved: Horner's syndrome (ptosis, miosis, anhidrosis, enophthalmos) - this is a classic exam combo!
Root level: C8, T1 (inferior trunk)
Quick Memory Map - The Whole Thing at a Glance
ROOTS TRUNKS DIVISIONS CORDS TERMINAL BRANCHES
C5 ββ
ββββ SUPERIOR βββ¬ββ Anterior ββββ LATERAL βββββ Musculocutaneous
C6 ββ β Lateral pectoral
βββ Posterior βββ (Lateral rootβ MEDIAN)
C7 ββββββ MIDDLE ββββ¬ββ Anterior β
β βββ POSTERIOR ββ Axillary
βββ Posterior βββ€ Radial
C8 ββ β Thoracodorsal
ββββ INFERIOR βββ¬ββ Anterior β Subscapulars
T1 ββ β βββ MEDIAL ββββ Ulnar
βββ Posterior Medial pectoral
Medial cutaneous (arm/forearm)
(Medial root β MEDIAN)
β
10-MARK ANSWER: Brachial Plexus
BRACHIAL PLEXUS
Definition: The brachial plexus is a network of nerves formed by the anterior rami of spinal nerves C5 to T1. It provides all motor and sensory innervation to the upper limb (except trapezius - spinal accessory nerve).
Formation & Components
The plexus is organized into 5 sequential components: Roots β Trunks β Divisions β Cords β Branches.
Roots (C5-T1):
The anterior rami of C5, C6, C7, C8, and T1 form the roots. They emerge between the anterior and middle scalene muscles.
Trunks (3):
- Superior trunk: C5 + C6
- Middle trunk: C7
- Inferior trunk: C8 + T1
Divisions (6):
Each trunk divides into anterior and posterior divisions (total 6). No nerves arise directly from divisions. Anterior divisions supply flexor compartments; posterior supply extensor compartments.
Cords (3): Named by their relation to the 2nd part of the axillary artery.
- Lateral cord (C5-C7): anterior divisions of superior + middle trunks
- Medial cord (C8, T1): anterior division of inferior trunk
- Posterior cord (C5-T1): all three posterior divisions
Branches
From Roots:
- Dorsal scapular (C5) - rhomboids
- Long thoracic (C5-C7) - serratus anterior
From Superior Trunk:
- Suprascapular - supraspinatus, infraspinatus
- Nerve to subclavius - subclavius
From Lateral Cord:
- Musculocutaneous - anterior compartment of arm + lateral forearm skin
- Lateral pectoral - pectoralis major
From Medial Cord:
- Ulnar nerve - intrinsic hand muscles, medial 1.5 fingers
- Medial pectoral - pec major + minor
- Medial cutaneous nerves of arm and forearm
From Posterior Cord:
- Axillary nerve (C5, C6) - deltoid, teres minor, skin over deltoid
- Radial nerve (C5-T1) - all posterior compartment muscles of arm and forearm
Median nerve is formed by lateral + medial roots from the lateral and medial cords respectively.
Clinical Injuries
1. Erb's (Duchenne's) Palsy (C5, C6 - Upper trunk injury):
Caused by forcible separation of neck and shoulder (e.g., birth injury, shoulder blow). Results in "Waiter's Tip" deformity: arm adducted, medially rotated, forearm extended and pronated, wrist flexed. Abduction, lateral rotation, flexion and supination of the forearm are lost.
2. Klumpke's Palsy (C8, T1 - Lower trunk injury):
Caused by sudden upward traction of the arm. Results in "Claw Hand" due to loss of intrinsic hand muscles. If sympathetic fibers of T1 are involved, Horner's syndrome (ptosis, miosis, anhidrosis) occurs on the same side.
Sources: Gray's Anatomy for Students (Gray's, p. 858-863)
Video Resource
This Ninja Nerd lecture is excellent for visual understanding: