On-line Brachial Plexus Review

By M. Tracy-Bee, PhD

 In this on-line session we will try to

gain a better understanding of the
brachial plexus.
Well also go through some questions
on the brachial plexus to ensure that
we are integrating our knowledge of
the brachial plexus and its resulting
pathologies appropriately.
Here we go

Here we see the brachial plexus in the schematic

that you have from your coursepak. There are
many other diagrams in other books including Grine
and Netter, but this will be the one that we will
use for this exercise.

 First and foremost, well label its

parts. You should have read through
your notes in your coursepak before
going through this exercise.

If its the first time going through this on-line

review, read through the answers. If you have
gone through a few times, then try to test
yourself.

Name this structure?

Answer: Lateral Cord

Name this structure?

Answer: upper trunk

Name this structure?

Answer: posterior division of

lower trunk

Name this structure?

Answer: Lateral pectoral nerve

Name this structure?

Answer: ventral ramus of T1

Name this structure?

Answer: long thoracic nerve

Name this structure?

Answer: Posterior Cord

Name this structure?

Answer: musculocutaneous nerve

Name this structure?

Answer: anterior division of

middle trunk

Name this structure?

Answer: Axillary Nerve

Name this structure?

Answer: Ulnar Nerve

Name this structure?

Answer: Median nerve

 How did you do?

Good, I hope, if not, you can go through this exercise as many times as
youd like.
Now that we know the names of the nervous tissue structures that make
up the brachial plexus, lets discuss the nerve fibers that can potentially
course through each structure.
Keep in mind that we are focusing on the formation of the brachial plexus
and which fibers could potentially course through each part of it. Dont
get this confused with your list of nerve root derivations, which is a listing
of the most common ventral rami found in each nerve. They however are
not what is always seen, due to individual variability. And its important to
know what fibers could be found in each part as you assess your patients.

 Lets look at the LONG THORACIC NERVE

We can see how it may have fibers from
C5, 6, and 7 in it. See the dashed red
lines.

 Now lets look at the AXILLARY NERVE

Lets follow its fibers backward to see
what ventral rami can potentially be
found within it.

AXILLARY NERVE
May contain ventral rami C5, C6, C7, C8
and T1

 You can try the next one,

Follow its fibers backward to see what
ventral rami can potentially be found
within the MUSCULOCUTANEOUS NERVE

 If you said, C5 and 6, that is only

partially correct.
It also contains fibers from C7.
Lets trace it back

Very Good.
Now lets try an example
question, which is similar to
what you may see on the
examination

Try this question.

5.Fibers coursing through T1
can also course through the
a. posterior division of the upper
trunk
b. middle trunk
c. medial root of the median nerve
d. lateral pectoral nerve
e. musculocutaneous nerve

What answer did you pick?

5.Fibers coursing through T1 can also course
through the
a. posterior division of the upper trunk
b. middle trunk
c. medial root of the median nerve
d. lateral pectoral nerve
e. musculocutaneous nerve

C is correct, lets see

5.Fibers coursing through T1 can also course
through the
a. posterior division of the upper trunk
b. middle trunk
c.medial root of the median nerve
d. lateral pectoral nerve
e. musculocutaneous nerve

 Lets think about applying this

knowledge clinically.
Suppose a patient experiences a neck
injury with impact at the level of C5
and C6. The ventral rami at these
levels are damaged
What nerves would be affected?

Nerves at the blue arrows would be damaged

as they may entirely be made up C5 and 6
Those nerves at the pink arrows may be
inhibited, or weakened because they are
made up by C5and6, as well as nerve fibers
from OTHER sources.

 You should now have a better

understanding of the brachial plexus.