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Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
All three cords give branches before proceeding as the terminal branches, which are detailed below. The lateral cord gives off the lateral pectoral nerve and the medial cord gives off the medial pectoral nerve, which together innervate the pectoralis major, which forward flexes, adducts and internally rotates at the shoulder. The medial cord also provides medial brachial cutaneous nerve and medial antebrachial cutaneous nerve which provide sensory innervation to the medial aspect of arm and forearm respectively.
Supraclavicular Brachial Plexus Blocks
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
Each cord also gives off infraclavicular branches:The lateral cord gives rise to the lateral pectoral nerve (C5 to C7), the musculocutaneous nerve (C5 to C7), and the lateral root of the median nerve (C6 and C7).The medial cord gives rise to the medial pectoral nerve, the medial cutaneous nerves of the arm and forearm (medial brachial and antibrachial cutaneous nerves), the medial root of the median nerve, and the ulnar nerve. All these nerves contribute fibers to, and are supplied by, fibers issuing from C8 and T1 spinal segments. Sometimes the ulnar nerve is supplied by fibers from the seventh cervical nerve.The posterior cord gives rise to the upper and lower subscapular nerves (C6 and C7), the circumflex (or axillary) nerve (C6 and C7), the radial nerve (C5 to T1), and the nerve to the latissimus dorsi muscle (the thoracodorsal nerve) (C6 to C8).
Techniques: Regional
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
The medial pectoral nerve (C8-T1) is a branch of the medial cord of the brachial plexus. It runs deep to pectoralis minor to supply pectoralis minor and major. The lateral pectoral nerve (C5-7) is a branch of the lateral cord of the brachial plexus and runs in the plane in between pectoralis minor and major to supply pectoralis major.
Everything pectoralis major: from repair to transfer
Published in The Physician and Sportsmedicine, 2020
Kamali Thompson, Young Kwon, Evan Flatow, Laith Jazrawi, Eric Strauss, Michael Alaia
The sternocostal head is the larger of the two muscles, making up 80% of the entire muscle volume and is composed of seven overlapping segments [3,27,32] (Figure 1). The sternocostal head originates from the second to sixth rib and the costal margin of the sternum with the fibers running upward and laterally. The inferior fibers of the pectoralis major are innervated by the medial pectoral nerve (C8-T1), which exits the medial cord of the brachial plexus, travels with the lateral thoracic artery to pierce the pectoralis minor at the midclavicular line and enters the pectoralis major at a mean of 11.0 cm medial to the humeral insertion (95% confidence interval 8.6–15.3 cm) and 2 cm proximal to the inferior edge [4,20,30]. Its’ primary role is the forward elevation of the humerus, as well as internal rotation, horizontal adduction, and extension. Tendons from both muscular heads converge laterally and insert on to the lateral lip of the bicipital groove of the humerus and the anterior lip of the deltoid tuberosity [30]. The crossing of the tendons occurs as the inferior sternocostal head rotates 180° transforming it into the posterior lamina, while the clavicular head becomes the anterior lamina [33].
Superficial location of the brachial plexus and axillary artery in relation to pectoralis minor: a case report
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
The brachial plexus innervates all the structures of the upper limb, and originates from spinal roots C5, C6, C7, C8 and T1, which are located between the anterior and middle scalene muscles.3 The trunks arise in the posterior triangle of the neck from the union of the roots; C5 and C6 roots join to form the superior trunk, C8 and T1 unite to form the inferior trunk, while C7 continues as the middle trunk. The trunks surround the first part of the axillary artery and pass over rib one, deep to the clavicle, where they each divide into anterior and posterior divisions. All three of the posterior divisions unite posterior to the axillary artery to form the posterior cord, the anterior divisions of the superior and middle trunk form the lateral cord on the lateral side of the axillary artery, while only the anterior division of the inferior trunk gives rise to the medial cord on the medial side of the artery. The cords are therefore named according to their position relative to the second part of the axillary artery and are situated deep to the pectoralis major and minor muscles. The terminal branches of the brachial plexus arise from the cords in the region of the third part of the axillary artery, inferior to the distal border of pectoralis minor, and supply skin and muscles of the upper limb.4 The lateral cord gives rise to the musculocutaneous nerve and the lateral root of the median nerve, the medial cord gives rise to the medial root of the median nerve and the ulnar nerve, and the posterior cord divides into the radial and axillary nerves.3