Pain in the shoulder joint: a neurologist's approach

Brachial plexus injuries

Damage to individual peripheral nerves and nerve plexuses.

In pediatric practice, lesions of the brachial plexus nerves are usually a consequence of pathological childbirth.

Plexus brachialis (brachial plexus)

The brachial plexus is composed of fibers of the anterior branches of the 5th, 6th, 7th, 8th cervical, 1st, 2nd thoracic spinal nerves. The upper trunk (truncus superior) of the brachial plexus is formed from the C5 and C6 spinal nerves, the middle trunk (fruncus medius) is a continuation of the C7 spinal nerve, and the lower trunk (truncus inferior) is formed from the fusion of the C8 and TI-T2 spinal nerves. The listed trunks of the brachial plexus are located in the supraclavicular fossa.

Damage to the entire brachial plexus causes flaccid atrophic paralysis and anesthesia of the upper limb with loss of the extensor-elbow, flexion-elbow and carporadial reflexes. With high lesions of the plexus, damage to the scapular muscles and the Claude Bernard-Horner symptom are added.

Damage to the C5-C6 spinal nerves or the upper trunk of the brachial plexus (Duchenne-Erb palsy) leads to loss of function of the axillary (m. deltoideus), musculocutaneous (mm. biceps, brachialis) and only partially radial (mm. brachioradialis, supinator) nerves . With radicular or very high lesions of the upper trunk, loss of function and scapular muscles (mm. supraspinatus, infmspinatus, subscapularis, serratus anterior) is associated. The ulnar-flexion reflexes are extinguished and the carporadial reflexes may be weakened.

Thus, upper paralysis is characterized by damage to the proximal part of the upper limb while the function of the hand and fingers is preserved. In this case, the distribution of the anesthetic zone occurs along the radicular (C5-C6) type on the outer surface of the shoulder and forearm.

Damage to the C8-T2 spinal nerves or the primary lower trunk of the brachial plexus (Dejerine-Klumpke palsy) causes complete loss of function of the ulnar, internal cutaneous nerves of the shoulder and forearm and partial damage to the median nerve and its lower leg.

The result is distal paralysis with predominant damage and atrophy of the small muscles of the flexors of the fingers and hand, the so-called lower plexus palsy. With a high lesion before discharge rr. communicantes (sympathetic fibers going to the eye), Horner's symptom is added. Sensitivity is impaired in a radicular (C8-T2) manner on the inner surface of the hand, forearm and shoulder.

Damage to the C7 spinal nerve or middle trunk plexus causes significant loss of function of the radial nerve and partially the median nerve.

The trunks of the brachial plexus are further divided into anterior and posterior branches. The anterior bundle (fasciculus lalemlis) is formed from the anterior branches of the upper and middle trunks (C5, C6, C7). From the anterior branches of the lower trunk (C8, T2) the internal bundle (fasciculus medialis) is formed. Finally, from all the posterior branches of the primary trunks (C5, C6, C7, C8, Tl, T2) the posterior bundle (fasciculus posterior) is formed. The names of the beams are determined by their location relative to a. axillaris.

The bundles of the brachial plexus are located in the subclavian fossa; further they form the actual nerves of the upper limb: external bundle - n. musculocutaneus and the upper leg of n. mediani; posterior bundle - n. axillaris et n. radialis and internal beam - n. ulnaris, lower leg n. mediani, nn. cutanei brachii et antebrachii medialis.

Damage to the external bundle of the brachial plexus causes complete disruption of the function of n. musculocutanei, partial - n. mediani (fibers of its upper leg, in particular m. pronator teres), and limited - n. radialis (mm. brachioradialis, supinator).

Thus, the similarity of the clinical picture of a lesion of the upper trunk of the brachial plexus and a lesion of the external bundle of the brachial plexus lies in the loss of the function of the musculocutaneous nerve in both cases and the limited loss of the function of the radial nerve.

The difference is that when the upper trunk of the brachial plexus is damaged, this combination also includes loss of function n. axillaris, which does not suffer when the external bundle of the brachial plexus is damaged, but in the latter case there is partial damage to n. mediani.

Lesions of the internal bundle of the brachial plexus and lesions of the lower trunk of the brachial plexus give a similar clinical picture, i.e., a combination of lesions n. ulnaris, nn. cutanei brachii et antebrachii mediales and partial lesions i. mediani (its lower leg). Horner's symptom in this case, as with more distal lesions, is not observed.

Damage to the posterior bundle of the brachial plexus is characterized by a combination of lesions n. axillaris et n. radialis (except for preserved mm. brachioradialis, supinator). The similarity with the clinical picture of damage to the middle trunk of the brachial plexus is the same loss of function n. radialis. The difference is that when the middle trunk is damaged, the function n. axillaris is preserved, but instead the function of n. mediani, its upper leg.

Thus, the fibers of the lower trunk of the brachial plexus become part of the internal bundle, which causes the similarity of the clinical picture when they are affected. N. radialis suffers in its main function both when the middle trunk and the posterior bundle are damaged, but in the first case (middle trunk) - in combination with partial damage to n. mediani, and in the second (posterior bundle) - with lesion n. axillaris.

Function n. axillaris falls out both when the upper trunk and the posterior bundle are affected due to the corresponding transition of its fibers.

Finally, and. musculocutaneus suffers equally when the upper trunk and the external bundle are affected, but in the first case (upper trunk) - in combination with, n. axillaris, and in the second (lower fascicle) with partial damage to n.mediani.

Nerves arising from the brachial plexus.

1. axillaris (axillary nerve ). The mixed nerve is composed of fibers of the C5, C6 and C7 spinal nerves, passing first as part of the upper trunk, then the posterior bundle of the plexus.

When the C5-C6 spinal nerves or the upper trunk of the brachial plexus (in the supraclavicular fossa) are damaged, as is observed with Erb's palsy, the nerve suffers in combination with n. musculocutaneus.

If the posterior bundle is damaged (in the subclavian fossa), the function n. axillaris is disrupted together with n. radialis.

The motor fibers of the nerve innervate m. deltoideus (et m. teres minor), sensitive - the skin of the outer surface of the shoulder (n. cutanei brachii lateralis).

When n. is affected. axillaris, there is atrophy of the deltoid muscle, the inability to raise the shoulder in the frontal plane to a horizontal line and impaired sensitivity on the skin of the outer surface of the shoulder.

1. musculocutaneus (musculocutaneous nerve). The nerve is mixed and is also formed from fibers of the C5-C6-C7 spinal nerves, passing through first the upper trunk, then the external fascicle of the brachial plexus.

When the C5-Cb spinal nerves or the upper trunk of the plexus (in the supraclavicular fossa) are damaged, as happens with Duchenne-Erb's palsy, it suffers in combination with n. axillaris.

If the external bundle is damaged (in the subclavian fossa), loss of function n. musculocutaneus is observed in conjunction with partial damage to I. mediani, its upper leg (weakening of pronation and palmar flexion of the hand).

The motor fibers of the nerve innervate m. biceps brachii (as well as m. brachialis et m. coracobrachialis), and sensitive - the skin of the outer (radial) surface of the forearm (n. cutanei anlebrachii lateralis).

When n. is affected. musculocutanei, atrophy of m occurs. bicipitis, the flexion-elbow reflex fades and flexion of the forearm is significantly weakened (it is completely impossible in the pronation position, since in the supination position or the average between them, flexion in the elbow joint can be carried out due to the contraction of the m. brachioradialis, innervated by the n. radialis.

Sensitivity disorders are observed on the outer (radial) surface of the forearm.

1. radialis (radial nerve ). The mixed nerve arises mainly from the fibers of the C7 spinal nerves (partly from C5, C6, C8 and T1), passing first as part of the middle trunk, then the posterior fascicle of the brachial plexus.

With damage to the C7 spinal nerves or the middle trunk, the main function of the nerve (except for the m.brachioradialis et m.supinator) is lost in combination with partial damage to the n.mediani, its upper leg (weakening of pronation and palmar flexion of the hand)

When the posterior bundle of the brachial plexus is damaged, the same basic functions of n. radialis, but in combination with damage to n. axillaris.

Motor fibers n. radialis innervates the extensors of the forearm (m. triceps et m. anconeus), hand (mm. extensores carpi radialis et carpi ulnares) and fingers (mm. extensores digitorum), the supinator of the forearm (m. supinator), the abductor pollicis muscle (m. abductor pollicis longus) and so on brachioradialis, which takes part in the flexion of the forearm. Sensitive fibers innervate the skin of the posterior surface of the shoulder (n. cutaneus brachii posterior), the dorsal surface of the forearm (n. cutaneus antebrachii dorsalis), the radial side of the dorsum of the hand and partially the first, second and sometimes third fingers.

With high damage n. radialis in the axillary fossa, in the upper third of the shoulder, paralysis of the extensors of the forearm, hand, main phalanges of the fingers, and the abductor pollicis muscle occurs; flexion of the forearm (m. brachioradialis) is weakened. The reflex from the m tendon fades away. triceps and the carporadial reflex is somewhat weakened (by turning off the contraction of the m. brachioradialis). Sensitivity is lost on the dorsal surface of the shoulder, forearm, and partly the hand and fingers. The zone of sensory disorders on the hand is often significantly reduced due to the overlap of the zone with the innervation of neighboring nerves. The joint-muscular feeling does not suffer. At lower levels of damage, the nerve function suffers to a limited extent, since the higher branches are preserved, which facilitates the tasks of topical diagnosis.

When the nerve is damaged, which is very common, at the level of the middle third of the shoulder, the function of extension of the forearm and the extension-ulnar reflex (m. triceps) are preserved and sensitivity in the shoulder is not impaired.

If the lower third of the shoulder is affected, the function of the m. brachioradialis and sensitivity on the dorsal surface of the forearm (n. cutaneus antebrachii dorsalis), since the corresponding branches extend from the main trunk of the nerve higher, in the middle third of the shoulder. When a nerve is damaged in the forearm, the function of n. brachioradialis et i. cutanei antebrachii dorsalis is usually preserved; loss is limited to damage to the extensors of the hand and fingers with sensory impairment only on the hand. With damage even lower, in the middle third of the forearm, loss of motor function can be even more limited; while extension of the hand is preserved, only extension of the main phalanges of the fingers may suffer.

When the radial nerve is damaged, weakness of the wrist extensors develops, and a typical falling or drooping hand occurs.

Among the numerous descriptions of samples or tests that determine movement disorders with damage to the radial nerve, the following can be noted:

1. Inability to straighten the hand and fingers.
2. Inability to abduct the thumb.
3. When the hands are folded together with the fingers straightened, the fingers of the affected hand are not retracted, but the bent ones seem to “slide” along the palm of the healthy, abducted hand.
4. ulnaris (ulnar nerve ). The nerve is mixed, made up of fibers of the C8-T1-T2 spinal nerves, passing through first the lower trunk, then the internal bundle of the brachial plexus.

With damage to the spinal nerves C8—T1—T2 of the lower trunk and the internal bundle of the brachial plexus, the function of the nerve suffers equally in combination with damage to the cutaneous internal nerves of the shoulder and forearm (nn. cutanei brachii et antebrachii mediates) and partial dysfunction of n. mediant, its lower leg (weakening of the tenor flexor muscles), which creates the clinical picture of Dejerine-Klumpke palsy.

The motor function of the nerve mainly consists of palmar flexion of the hand, flexion of fingers V, IV and partly III (mm. lumbricales, flexor digitorum profundus, interossei, flexor digiti V), adduction of the fingers, their spread (mm. interossei) and adduction of the thumb ( m. adductorpollicis); in addition, in the extension of the middle and terminal phalanges of the fingers (t. lumbricales. interossei).

With regard to the innervation of the movements of the 1st and 2nd fingers, the function of the ulnar nerve is associated with the function of the median nerve; the first has a predominant relation to the function of the 5th and 4th fingers; the median nerve to the function of the 2nd and 3rd fingers. Sensitive fibers innervate the skin of the ulnar edge of the hand, V and partially IV, and less often III fingers.

Complete damage to the ulnar nerve causes weakening of the palmar flexion of the hand (flexion is maintained partially due to the m. flexor carpi radialis et m. palmaris from the n. medianus), lack of flexion of the IV and V, and partly of the III fingers, the impossibility of bringing and spreading the fingers, especially the V and IV, inability to adduct the thumb.

Superficial sensitivity is usually impaired on the skin of the fifth and ulnar half of the fourth fingers and the corresponding ulnar surface of the hand.

The joint-muscular feeling is upset in the little finger. Pain with damage to the ulnar nerve is not uncommon, usually radiating to the little finger. Possible cyanosis, sweating disorders and a decrease in skin temperature in an area approximately coinciding with the area of ​​sensory disorders. Atrophy of the muscles of the hand with damage to t. ulnaris appears clearly, depression of the interosseous spaces, especially the first, as well as a sharp flattening of the hypotenor are noticeable.

As a result of the defeat of mm. interossei et lumbricalis, the hand takes the form of a “clawed bird’s paw”; with hyperextension of the main phalanges, bending of the middle and terminal phalanges is observed, due to which the fingers take a claw-like position. This is especially pronounced in relation to the V and IV fingers. At the same time, the fingers are slightly separated, especially the IV and mainly V fingers.

Its first branches n. ulnaris radiates only to the forearm, so its lesion along the entire length to the elbow joint and the upper part of the forearm gives the same clinical picture.

The lesion in the region of the middle and lower thirds of the forearm leaves the innervation of mm intact. flexor carpi ulnaris et flexor digitorum profundus, due to which palmar flexion of the hand and flexion of the terminal phalanges of the V and IV fingers are not affected. But the degree of “clawedness” of the hand increases.

To determine movement disorders that occur when the ulnar nerve is damaged when the hand is clenched into a fist, the following basic tests are available:

1. When the hand is clenched into a fist, fingers V and IV, and partly III, are not bent enough.
2. Bending the terminal phalanx of the fifth finger or “scratching” the little finger on the table with the palm tightly fitting to it is not possible.
3. It is impossible to adduct the fingers, especially V and IV.
4. Thumb test: the patient stretches a strip of paper, grasping it with both hands between the bent index finger and straightened thumb; with damage to the ulnar nerve and, consequently, paralysis of the m. adductoris pollicis adduction of the thumb is impossible and the strip of paper is not held with the straightened thumb. In an effort to hold the paper, the patient bends the terminal phalanx of the thumb with the help of m. flexor pollicis, innervated by the median nerve.
5. medianus (median nerve ). The mixed nerve is formed from fibers of the C5, C6, C7, C8 and T1 spinal nerves, passing mainly through the middle and lower trunks of the brachial plexus. Subsequently, the fibers of the median nerve pass in the external and internal bundles. The upper leg of the n. extending from the external bundle. mediani and from the internal bundle its lower leg merge, forming a loop of the median nerve.

When the C7 spinal nerve or the middle trunk of the brachial plexus is damaged, the function of the median nerve suffers partly as a result of weakening of wrist flexion (m. flexor carpi radialis), pronation (mm. pronalores) in combination with damage to the radial nerve.

Almost the same loss of function n. mediani occurs when the external bundle of the brachial plexus is damaged, into which the fibers of the upper peduncle of the nerve pass from the middle trunk, but in combination with damage to the musculocutaneous nerve.

With damage to the C8-T1 spinal nerves, the lower trunk and the internal bundle of the brachial plexus (Dejerine-Klumpke palsy), they suffer in combination with damage to n. ulnaris, n. cutanei brachii el anlebrachii medialis fibers n. medianus, which make up its lower leg (weakening of the flexors of the fingers and tenor muscles).

The motor function of the nerve mainly consists of pronation, palmar flexion of the hand due to contraction of m. flexor carpi radialis el m. palmaris longus flexion of fingers, mainly I, II and III (mm. lumbricales flexor digitorum sublimis el pmfundus, flexorpollicis), extension of the middle and terminal phalanges of II and III fingers.

Sensory fibers etc. mediani innervate the skin of the palmar surface of the I, II, III and radial half of the IV fingers, the corresponding part of the palm, as well as the skin of the rear of the terminal phalanges of these fingers.

When the median nerve is damaged, pronation suffers, palmar flexion of the hand is weakened (preserved only by the m. flexor carpi ulnaris from n. ulnaris), flexion of the I, II and III fingers and extension of the middle phalanges of the II and III fingers (mm. lumbricalis, inlerossei) are impaired. . Superficial sensitivity is impaired in the hand in an area free from the innervation of the ulnar and radial nerves. Articular-muscular sensation is always impaired in the terminal phalanx of the index, and often in the second finger. Muscle atrophy with damage to the median nerve is most pronounced in the tenor area. The resulting flattening of the palm and bringing the thumb close and in one plane to the index finger create a peculiar position of the hand, which is called “monkey”.

Pain when the median nerve is damaged, especially partial, is quite intense and often takes on a causal nature. In the latter case, the position of the hand may become bizarre. Vasomotor-secretory-trophic disorders are also common and characteristic of lesions of the median nerve: the skin, especially the 1st, 2nd and 3rd fingers, becomes bluish or pale in color; nails become “dull”, brittle and streaked; skin atrophy, thinning of fingers (especially II and III), sweating disorders, hyperkeratosis, hypertrichosis, ulcerations, etc. are observed. These disorders, as well as pain, are more pronounced with partial rather than complete damage to n. medianus.

Its first branches n. medianus, like n. ulnaris, radiates only to the forearm, so the clinical picture with high damage along the entire length from the axillary fossa to the upper parts of the forearm is the same.

When n. is affected. mediani in the middle third of the forearm, in which the branches extending to mm. pronator leres, flexor carpi radialis, palmaris longus flexor sublimis, the functions of pronation, palmar flexion of the hand and flexion of the middle phalanges are not affected. With lower nerve lesions, the function of flexion of the terminal phalanges of the I, II and III fingers may also be preserved.

The main tests to determine movement disorders arising from damage to the median nerve are the following:

1. When squeezing the hand and fist, fingers I, II and partly III do not bend
2. Bending the terminal phalanges of the thumb and index fingers is impossible, as is scratching the index finger on the table with the hand tightly fitting to it.
3. During the thumb test, the patient cannot hold a strip of paper with a bent thumb and will hold it by adducting with a straightened thumb (mm. adductor policis from retained n. ulnaris).
4. cutaneus brachii medialis (cutaneous internal nerve of the shoulder ). A sensory nerve, the fibers of which arise from C8, T1, partly from T2 spinal nerves and pass through first the lower trunk, then the internal bundle of the brachial plexus and innervate the skin of the inner surface of the shoulder. When it is damaged, sensory disturbances and pain in the shoulder area occur.
5. cntaneus antibrachii medialis (cutaneous internal nerve of the forearm). Sensory nerve. Innervates the skin of the inner surface of the forearm. It is formed from the C8-T2 spinal nerves.

When the nerve is damaged, sensory disturbances occur, and possibly pain in the forearm area.

Isolated lesions of these nerves are rare. Their damage is often included in the clinical picture of damage to the lower trunk or internal bundles of the brachial plexus or is observed in combination with damage to other nerves of the limb.

The main challenge that must be resolved to select appropriate treatment is to determine the level of damage as accurately and early as possible.

Indications for neurosurgical operations are clinical signs of severe upper and total paralysis, Horner's syndrome, relaxation of the diaphragm, lack of restoration of motor and sensory functions of the upper limb in infants. The most optimal age of patients for neurosurgical operations is the first year of life. For operations on the brachial plexus, the transverse supraclavicular approach and its modifications, as well as the transclavicular one, are used. The methods of choice for neurosurgical operations are external and internal neurolysis, plastic surgery and suture of nerves, neurotization

A comparison of groups of children treated only conservatively and with the use of neurosurgery showed that the latter significantly improves outcomes.

Major diseases

In 40% of cases, impairment of motor or sensory functions of the shoulder is associated with injuries to the brachial plexus.
Pathologies of the brachial plexus:

• Neuropathy. Degenerative-dystrophic damage to nerve fibers. The main reasons are diabetes and alcohol addiction. The pathological process covers one or more bundles.
• Neuroma. Most often localized in the upper primary column. This is a dense tumor up to 4 cm in size and has a smooth surface.
• Neuritis. Inflammation of the nerves due to a viral or bacterial infection or injury.

Pathologies are accompanied by shooting, aching pain. The location of the pain syndrome is from the shoulder to the elbow, hand, sometimes radiating to the scapula. Paralysis, paresis, numbness, and muscle atrophy occur. Unpleasant sensations intensify at night. Additionally, there is swelling, coldness of the upper extremities, and the skin acquires a bluish tint. In 30% of cases, the disease becomes chronic.

Links[edit]

1. ^ a b Kawai, H; Kawabata, H (2000). Brachial plexus palsy
   . Singapore: World Scientific. pp. 6, 20. ISBN 9810231393.
2. ^ abcd Saladin, Kenneth (2015). Anatomy and Physiology
   (7th ed.). New York: McGraw Hill. pp. 489–491. ISBN 9789814646437.
3. Goel Shivi; Rustagi, S.M.; Kumar, A; Mehta, V; Suri, R. K. (13 March 2014). "Multiple unilateral variations of the medial and lateral funiculi of the brachial plexus and their branches". Anatomy and Cell Biology
   .
   47
   (1):77–80. DOI: 10.5115/acb.2014.47.1.77. PMC 3968270. PMID 24693486.
4. Moore, K. L.; Agur A. M. (2007). Basic clinical anatomy
   (3rd ed.). Baltimore: Lippincott Williams and Wilkins. pp. 430–1. ISBN 978-0-7817-6274-8.
5. Saladin, Kenneth (2007). Anatomy and Physiology: The Unity of Form and Function. New York, NY: McGraw-Hill. P. 491. ISBN 9789814646437.
6. "Axillary brachial plexus block". www.nysora.com
   . New York School of Regional Anesthesia. 2013-09-20. Archived from the original on 2017-07-12.
7. Cooper, Delaware; Jenkins, R.S.; Brady, L; Rockwood Jr., C. A. (1988). "Prevention of brachial plexus injuries due to incorrect patient positioning during surgery." Clinical Orthopedics and Related Research
   (228): 33–41. DOI: 10.1097/00003086-198803000-00005. PMID 3342585.
8. Jeyaseelan, L.; Singh, VK; Ghosh, S.; Sinisi, M.; Fox, M. (2013). "Iatropathic brachial plexus injury: a complication of untimely fixation of clavicle fractures." Bone & Joint Magazine
   .
   95-B
   (1): 106–10. DOI: 10.1302/0301-620X.95B1.29625. PMID 23307682.
9. Midha, Rajeev (1997). "Epidemiology of brachial plexus injuries in a multi-injury population." Neurosurgery
   .
   40
   (6): 1182–8, discussion 1188–9. DOI: 10.1097/00006123-199706000-00014. PMID 9179891.
10. Ecker, Jeffrey L.; Greenberg, James A.; Norwitz, Errol R.; Nadel, Allan S.; Repke, John T. (1997). "Birth weight as a predictor of brachial plexus injury." Obstetrics and gynecology
    .
    89
    (5): 643–47. DOI: 10.1016/S0029-7844 (97) 00007-0. PMID 9166293.
11. Moore, Kate (2006). Clinically Oriented Anatomy. Philadelphia: Lippincott Williams and Wilkins. pp. 778–81. ISBN 0-7817-3639-0.
12. ↑
    Elias, Ilan.
    "Recurrent burn syndrome due to suspected cervical spine osteoblastoma in an athlete with a collision—a case report". Journal of Brachial Plexus and Peripheral Nerve Injury
    . Retrieved 12/02/15. Check date values ​​in: |access-date=(help)
13. Cunnane, M (2011). "A retrospective study examining the prevalence of bite injuries in professional rugby union players". British Journal of Sports Medicine
    .
    45
    (15):A19. DOI: 10.1136/bjsports-2011-090606.60. Retrieved 12/02/15. Check date values ​​in: |access-date=(help)
14. "Brachial Plexus Injury Information Page: National Institute of Neurological Disorders and Stroke (NINDS)". www.ninds.nih.gov
    . Retrieved November 28, 2021.
15. Doumouchtsis, Stergios K.; Arulkumaran, Sabaratnam (09/01/2009). “Are all brachial plexus injuries caused by shoulder dystocia?” Obstetric and gynecological examination
    .
    64
    (9):615–623. DOI: 10.1097/OGX.0b013e3181b27a3a. ISSN 1533-9866. PMID 19691859.

Function [edit]

The brachial plexus provides the nerve supply to the skin and muscles of the arms, with two exceptions: the trapezius muscle (supplied by the spinal accessory nerve) and the area of ​​skin near the axilla (supplied by the intercostobrachial nerve). The brachial plexus communicates through the sympathetic trunk through the gray communicants of the branches, which connect to the roots of the plexus.

The terminal branches of the brachial plexus (musculocutaneous, axillary, radial, median and ulnar) have specific sensory, motor and proprioceptive functions. [5] [6]

Content

• 1 Structure 1.1 Roots
• 1.2 Trunks
• 1.3 Divisions
• 1.4 Cords
• 1.5 Scheme
• 1.6 Branches

Additional images[edit]

• The brachial plexus surrounds the brachial artery.
• Nerves of the subclavian part of the right brachial plexus in the axillary fossa.
• The outer (distal) part of the brachial plexus is shown on a sectioned cadaveric specimen.
• Brachial plexus
• Mind map showing the branches of the brachial plexus
• Spinal cord. Brachial plexus. Brain. View from below. Deep dissection.
• Diagram of the brachial plexus using color to illustrate the contribution of each nerve root to the branches.
• Brachial plexus, including all branches of the ventral primary rami C5-T1. Includes mnemonics for exploring the connections and branches of the plexus.
• Mixed fibers of the spinal nerve