1. Nerve Supply of the Upper Limb
The Brachial Plexus

2. Learning Outcomes after this session you should be able to…
Describe the basic anatomy and course of the brachial plexus
Describe the distribution of all branches of the plexus
Describe the course of the major nerves and identify where each is vulnerable to injury
Identify the dermatomes of the upper limb
Predict the effects of damage to nerve roots, the plexus and peripheral nerves based on anatomical knowledge

3. Anatomy of the plexus

4. Brachial Plexus Drake et al (2005) Gray’s Anatomy for Students (Publ Elsevier)

5. Brachial plexus in context Ref: Drake et al (2005), Gray’s Anatomy for Students Flash Cards, Elsevier

6. Course of the brachial plexus
Trunks
Emerge between anterior & middle scalenes
Palpable between the clavicle and lower part of the posterior border of SCM
Divisions
Posterior to clavicle, between clavicle & 1st rib
Cords
Lie around the axillary artery; initially between 1st ICS & clavicular ehad of pec major; then between subscapularis & pectoral muscles
Palpable in the axilla

7. Supraclavicular branches
Dorsal scapular n
Long thoracic n (of Bell)
N to subclavius
Suprascapular n

8. Infraclavicular branches
Lateral pectoral n
Medial pectoral n
Superior subscapular n
Inferior subscapular n
Thoracodorsal n
Medial cutaneous n of the arm
Medial cutaneous n of the forearm
Axillary n
Musculocutaneous n
Radial n
Ulnar n
Median n
“minor” nerves – know distribution
“major” nerves – course & distribution

9. Dermatomes of the upper limb Ref: Gilroy, Mac Pherson & Ross (2008) Atlas of Anatomy

10. Cutaneous Innervation Ref: Gilroy, Mac Pherson & Ross (2008) Atlas of Anatomy

11. Key Words Dermatome Myotome Cutaneous nerve Prefixed brachial plexus
Postfixed brachial plexus
Roots
Trunks
Divisions
Cords
Supraclavicular branches
Infraclavicular branches
Course
Distribution
Carpal tunnel syndrome
Palsy
Paraesthesia
Anaesthesia
Paresis
Paralysis
Erb’s palsy
Klumpke’s palsy