Nerve Supply

Objectives
***to follow
o
NERVE SUPPLY OF UPPER LIMBS
Spinal Nerves = 31 pairs (total)
o Cervical (C) = 8
o Thoracic (T)= 12
o Lumbar (L)= 5
o Sacral (S)= 5
o Coccygeal (Co) = 1
innervations from a single spinal

cord segment or spinal nerve
NOTE: upper limb muscles
usually receive motor fibers
from several spinal cord
segments/nerves
Dermatome
area of the skin supplied by any

one spinal nerve through both
its rami
dermatomes of consecutive
spinal nerves overlap markedly
Figure 1: Formation of a typical

spinal nerve
Components:
o Dorsal root (afferent or sensory fibers):
formed by processes of pseudounipolar
neuron in dorsal root ganglion
o
Ventral root (efferent or motor fibers):

formed by axon of neurons on anterior
horn and lateral horn (T1 L2 or L3) of
spinal cord
Spinal nerves formed by the dorsal and

ventral roots are mixed nerves, exit
through the intervertebral foramina of
the vertebral column and divide into
dorsal and ventral primary rami
Dorsal Primary Rami
Generally supply deep muscle

and skin of posterior regions of
neck and trunk (except C1 and
C0)
Ventral Primary Rami
C1-C4
form cervical plexus
supply some neck

muscles and parts of
skin of head, neck and
chest
C5-C8 & T1
form brachial plexus

to supply upper limb
Figure 2: Dermatomal distribution of the spinal

nerves
I.
Cervical Plexus
Figure 3: The cervical plexus
Somatic plexus
formed by the
anterior rami of
C1-C4 & lies in
front of the
origins of the
Levator
scapulae &
middle scalene
ms
Cutaneous
(superficial) &
motor (deep)
branches
II. Brachial
Plexus
Somatic plexus formed by the ventral rami of
C5-C8 & most of the ventral rami of T1
Components (from proximal to distal):
Myotome
The unilateral embryological

muscle mass receiving
Page 1
thoracic
wall
2. Inability to perform overhead actions:
SA unable to rotate the glenoid cavity
superorly
Figure 5: Winging of
the (R) scapula due to
weakness of SA ms
Figure 4: The brachial plexus divided

into Roots, Trunks, Divisions, Cords &
Branches.
*Mnemonics
Really Thirsty? Drink Cold
Beer.
ROOTS
Primarily ventral rami of spinal nerves C5-T1
Emerge between 2 scalene ms
Combines to form 3 trunks
Branches:
o Dorsal scapular nerve/DSN (C5):
Rhomboids, Levator Scapulae
Action: elevation of scapula
Deficit: inability to raise arm

beyond horizontal; scapula will
also move farther from midline
o Phrenic nerve (C3-C5):
Innervates diaphragm
o Long Thoracic nerve/LTN (C5-C7):
Serratus Anterior (SA)
Paralysis of LTN=
1.
Scapula
r
winging
: medial
border
of
scapula
moves
laterally
&
posterior
ly away
from the
thoracic
wall;
recall
that the
SA holds
the
scapula
against
the
TRUNKS
3 trunks
o Superior/Upper: C5-C6; Erbs Point
o Middle: C7
o Inferior/Lower: C8
Branches only from superior

o Nerve to
subclavius:
(supplies)
subclavius
o Suprascapular
n.: supraspinatus
& infraspinatus
Injury at this area causes:
Erbs Palsy
o Waiters Tip
position
o Traction of C5-C6
(& occasionally
C7) roots during
normal vaginal
delivery or landing
on the shoulder
from a fall
Figure 6: Erb-Duchenne Palsy aka Waiters
tip deformity d/t traction or tearing of the
C5-C6 nerve roots
o
Affectation:
Musculocutaneous n.
Axillary n.
Subscapular n.
Presentation:
Arms drooped & in medial

rotation; cannot be raised
No elbow flexion
No forearm supination
Klumpkes Palsy
o Claw Hand
o Traction or avulsion of C8, T1 (&
occasionally C7) roots due to excessive
abduction of the arm
Page 2
Presentation:
Forearm supinated
Wrist & proximal phalanges

hyperextended
Distal phalanges in neutral
Figure 7: Klumpkes Palsy

DIVISIONS
Each Trunk divides into an ANTERIOR (flexor) &

POSTERIOR (extensor) division
No terminal branches
CORDS
LATERAL CORD
o Branches:
Lateral pectoral n.: supplies pectoralis
major
Musculocutaneous n.
Lateral part of Median n.
POSTERIOR CORD
o Branches
Superior subscapular n.: supplies
subscapularis
Thoracodorsal n.
May be due to surgery in the inferior
part of the axilla, mastectomies, surgery
on scapular lymph nodes
Inability to raise the trunk with the
upper limbs (as in climbing)
Will also be unable to use an axillary
crutch
Inferior subscapular n.: supplies
subscapularis & teres major
Axillary n.
May be damaged by compression from
incorrect use of axillary crutches (Crutch
Palsy) or during intramuscular injection
of drugs
Will lead to atrophy of deltoid ms & loss
of sensation over the lateral side of the
proximal part of the arm
Radial n.
Saturday Night Palsy (note right

UE)
Figure 8: Saturday Night Palsy

due to compression of radial n.
at the level of the spiral
groove; results to wrist drop &
sensory loss over the dorsum of
the hand & proximal segment of
lateral 3 fingers
Radial n. palsy or wrist drop
Figure 9: Wrist drop as a result of Saturday

Night Palsy
MEDIAL CORD
o Branches:
Medial pectoral n.
Medial cutaneous n. of arm
Medial cutaneous n. of forearm
Medial part of Median n.
Ulnar n.
Claw hand deformity/Papal sign
Figure 10: Claw hand deformity or Papal sign due to

ulnar nerve involvement. Note guttering of hand due to
atrophy of intrinsic ms.
Page 3
BRANCHES
MUSCULOCUTANEOUS N.
o Motor: Coracobrachialis, biceps brachii
& brachialis
o Cutaneous: skin along the lateral
border of the forearm through the
lateral cutaneous n. of the forearm
MEDIAN NERVE
o Motor: ALL muscles in the anterior
compartment of the forearm (except
FCU & medial half of FDP), the thenar
ms & 2 lateral lumbricals
o Cutaneous: skin over the palmar
surface of the lateral 3 digits & over
the lateral side of the palm & middle of
the wrist
ULNAR NERVE
o
o
Motor: FCU, FDP (medial half) & all

intrinsic ms of the hand (except the 3
thenar ms & 2 lateral lumbricals)
Cutaneous: skin over the palmar
surface of the little finger, medial half of
the ring finger & skin over the dorsal
surface of the medial part of the hand
Passes through the ulnar or Guyons
canal at the level of the flexor
retinaculum
AXILLARY NERVE
o Motor: Deltoids & Teres Minor
o Cutaneous: skin over lower 2/3 of
Deltoid
RADIAL NERVE
o Motor: supplies all muscles of the
posterior compartment of the arm &
forearm
o Cutaneous: skin over the posterior
aspect of the arm & forearm, lower
lateral surface of the arm & the dorsal
lateral surface of the hand
Page 4
Figure 12: Diagram of the brachial plexus

showing pathway & innervations. Draw it to
know it
Figure 11: Diagram of the cervical plexus showing

pathway & innervations. Draw it to know it
References:
Moore, K.L., Dalley, A.F. & Agur, A.M.R. (2010).

Clinically Oriented Anatomy (6th ed.).
Snell, R.S. (2004). Clinical Anatomy (7th ed.).
Page 5

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Objectives

innervations from a single spinal

area of the skin supplied by any

Figure 1: Formation of a typical

Ventral root (efferent or motor fibers):

Spinal nerves formed by the dorsal and

Dorsal Primary Rami

Generally supply deep muscle

Ventral Primary Rami

form cervical plexus

supply some neck

form brachial plexus

Figure 2: Dermatomal distribution of the spinal

The unilateral embryological

Figure 4: The brachial plexus divided

Primarily ventral rami of spinal nerves C5-T1

Emerge between 2 scalene ms

Combines to form 3 trunks

Rhomboids, Levator Scapulae

Action: elevation of scapula

Deficit: inability to raise arm

Serratus Anterior (SA)

Branches only from superior

Arms drooped & in medial

Wrist & proximal phalanges

Distal phalanges in neutral

Figure 7: Klumpkes Palsy

Each Trunk divides into an ANTERIOR (flexor) &

Saturday Night Palsy (note right

Figure 8: Saturday Night Palsy

Figure 9: Wrist drop as a result of Saturday

Claw hand deformity/Papal sign

Figure 10: Claw hand deformity or Papal sign due to

Motor: FCU, FDP (medial half) & all

Figure 12: Diagram of the brachial plexus

Figure 11: Diagram of the cervical plexus showing

Moore, K.L., Dalley, A.F. & Agur, A.M.R. (2010).

Snell, R.S. (2004). Clinical Anatomy (7th ed.).

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