Anatomy and Evaluation of

the Brachial Plexus

San Jose State University
Undergraduate Athletic Training
Educational Program

Contents

Anatomy of the Brachial Plexus

Mechanisms of Brachial Plexus Injury

and Pathologies

Neurological Evaluation for the Brachial

Plexus and Related Special Tests

Anatomy

Levels
Roots

Real

Trunks

Divisions

Drink

Cords

Cold

Branches

Beer

Athletic

Trainers

Brachial Plexus Branches &

Muscular Innervations
Dorsal Scapular N.

Levator Scapulae
Rhomboid Major/Minor

Lateral Pectoral N.

Pectoralis Major/Minor

Suprascapular N.

Infraspinatus
Supraspinatus

Musculocutaneous N.

Biceps Brachii
Brachialis
Coracobrachialis

Brachial Plexus Branches &

Muscular Innervations
Axillary N.
Deltoid
Teres Minor

Middle Subscapular or
Thoracodorsal N.
Latissimus Dorsi

Upper Subscapular N.
Subscapularis

Lower Subscapular N.
Subscapularis
Teres Major

Brachial Plexus Branches &

Muscular Innervations
Median N.

Abductor Pollicis
Brevis/Longus
Flexor Carpi Radialis
Flexor Digitorum
Superficialis
Flexor Digitorum Profundus
(Lat. 2)
Flexor Pollicis Brevis (Lat.)
& Longus
Lumbricales (Lat. 2)
Opponens Pollicis
Palmaris Longus
Pronator Quadratus
Pronator Teres *

Radial N.

Abductor Pollicis Brevis

Anconeus
Brachioradialis
Extensor Carpi Radialis
Brevis/Longus
Extensor Carpi Ulnaris
Extensor Digiti Minimi
Extensor Digitorum
Communis
Extensor Indicis
Extensor Pollicis
Brevis/Longus
Supinator
Triceps Brachii

Brachial Plexus Branches &

Muscular Innervations
Ulnar N.

Abductor Digiti Minimi

Adductor Pollicis
Dorsal Interossei
Flexor Carpi Ulnaris
Flexor Digiti Minimi
Flexor Digitorum
Profundus (Med. 2)
Flexor Pollicis Brevis
(Med.)
Lumbricals (Med. 2)
Opponens Digiti Minimi
Palmar Interossei

Long Thoracic N.
Serratus Anterior
Medial Pectoral N.
Pectoralis Major
Medial Brachial
Cutaneous N. (sensory)
Medial Antebrachial
Cutaneous N. (sensory)

Mechanisms of
Injury to the Brachial Plexus

Brachial Plexus Injury Overview

Sports most commonly associated with brachial

plexus injuries include: football, baseball,
basketball, volleyball, fencing, wrestling, and
gymnastics

Nerve injuries can result from blunt force trauma,

poor posture, or chronic repetitive stress

Patients generally present with pain and/or

muscle weakness

Over time, some patients may experience

muscle atrophy
(Duralde, 2000)

Brachial Plexus Injury Overview

Before performing special tests, rule out fractures

and dislocations
Brachial plexus injuries resolve quicker than spinal
cord injuries
(Prentice, p.846)

Evaluation for return-to-play should take into

consideration symptoms, resolution time, and prior
injuries to this region
(Gorden, et al., 2003)

Evaluate athletes immediately after injury and again

after the game/practice
(Kuhlman & McKeag, 1998)

Three Mechanisms of Injury

Percussion

Traction

Cervical

Nerve Compression

Percussion
Occurs with direct blow to the
supraclavicular fossa over Erbs point
(Troub, 2001)

Example: Cross-check to a hockey

player

Traction
Occurs with a direct blow to the
shoulder with the neck laterally flexed
toward the unaffected shoulder
(Troub, 2001)

Example: Gymnast falls on beam

Cervical Nerve Compression

Occurs when the neck is flexed laterally
toward the patients affected shoulder
Caused by compression or irritation of the
nerves, resulting in point tenderness over
involved vertebrae of affected nerve(s)
(Troub, 2001)

Example: Football player tackles an

opponent

A. Traction
B. Percussion
C. Cervical Nerve Compression

Brachial Plexus Pathologies

Burners

or Stingers

Associated with traction and/or compression

Thoracic

Outlet Syndrome

Burners or Stingers

Mechanisms of injury include cervical flexion

away from the limb and hyperextension of the
cervical spine

May present with pain, numbness, burning,

and/or tingling from the shoulder to the fingers

Possible loss of function in arm and hand for

several minutes up to several days
(Prentice, p.846)

Thoracic Outlet Syndrome

Caused by pressure on the brachial plexus

and/or subclavian artery and/or vein

May present with numbness, paresthesia, pain,

cool and pale skin, cyanosis or edema in upper
extremity, and swollen veins
(Prentice, pp. 683-684)

Patient may also develop unilateral atrophy

and/or lowered shoulder on affected side
(Duralde, 2000)

Three Grades of Injury

Grade 1 Neuropraxia

Grade 2 Axonotmesis

Grade 3 Neurotmesis

Grade 1 - Neuropraxia

Results in a disruption in the function of a

nerve that produces numbness and
tingling

Most common grade within athletics

Symptoms usually resolve within several

minutes
(Duralde,2000)

Grade 2 - Axonotmesis

Damage to the nerves axon

Symptoms include numbness, tingling,

and affected function (may last several
days)

Long nerves have a greater healing time

than short nerves

Rare within athletics

(Duralde,2000)

Grade 3 - Neurotmesis

Permanent nerve damage occurs

Very rare within athletics

Occurs with high-energy trauma,

fractures, and penetrating injuries
(Duralde, 2000)

C5-C6 Affected

Motor Deficits:
Shoulder abduction, shoulder flexion,
elbow flexion, and wrist extension

Sensory Loss:
Lateral arm, 1st digit, and 2nd digit

C7 Affected

Motor Deficits:
Elbow extension weakness and wrist flexion

Sensory Loss:
Pad of index finger

C8-T1 Affected (very rare)

Motor Deficits:
Finger abduction/adduction and thumb
flexors/extensors

Sensory Loss:
4th digit, 5th digit, medial forearm, and
medial arm

C5-T1 Affected

Motor Deficits:
Scapular motion and entire arm

Sensory Loss:
Entire arm, forearm, and hand

Process of Evaluation

Dermatomes

C5 Lateral arm

C6 Lateral forearm, thumb, index finger

C7 Posterior forearm, middle finger

C8 Medial forearm, ring and little finger

T1 Medial arm

Myotomes

C5 Shoulder abduction

C6 Elbow flexion or wrist extension

C7 Elbow extension or wrist flexion

C8 Grip strength, shake hands

T1 Interossei, spread fingers and resist

finger adduction

Peripheral Nerve Tests

Axillary N.
Sensory Lateral
arm

Musculocutaneous N.
Sensory Anterior
arm

Motor Shoulder
abduction

Motor Elbow
flexion

Peripheral Nerve Tests

Radial N.
Sensory 1st Dorsal
web space
Motor Wrist
extension and thumb
extension

Median N.
Sensory Pad of
Index finger
Motor Thumb pinch
and abduction
Ulnar N.
Sensory Pad of little
finger
Motor Finger
abduction

Reflex Tests

C5 Biceps brachii reflex (anterior arm

near antecubital fossa)

C6 Brachioradialis reflex (lateral aspect

of forearm)

C7 Triceps brachii reflex (at insertion of

tricep brachii)

C8 and T1 do not have reflex tests

Related Special Tests

Brachial Plexus
Cervical Compression
Test

Cervical Distraction
Test
Spurlings Test
Brachial Plexus
Traction Test

Thoracic Outlet Syndrome

Adsons Test

Allens Test
Military Brace Position

References
Duralde, X. A. (2000). Neurologic injuries in athletes shoulder. Journal
of Athletic Training, 35(3), pp.316-318.
Gorden, J. A., Straub, S. J., Swanik, C. B., & Swanik, K. A. (2003).
Effects of football collars on cervical hyperextension and lateral
flexion. Journal of Athletic Training, 38(3), pp. 209-218.
Hoppenfeld, S. (1976). Physical Examination of the Spine & Extremities.
Upper Saddle River: NJ: Prentice Hall. pp.93-127.
Kuhlman, G. S. & McKeag, D. B. (1999). The burner: A common nerve
injury in contact sports. American Family Physician, 60(7). Retrieved
April 5, 2006 from the American Academy of Family Physicians
database.
Martini, F. H., Timmons, M. J., & Tallitsch, R. B. (2003). Human
Anatomy. Upper Saddle River, NJ: Pearson Education, Inc.
Starkey, C. & Ryan, J. (2002). Evaluation of Orthopedic and Athletic
Injuries. Philadelphia, PA: F. A. Davis Company.
Troub, M. (2001). Brachial plexus injuries in athletics:
Burners. Northwest Texas Sports Medicine Clinic. Retrieved March
5, 2006 from the Northwest Texas Sports Medicine Clinic website.

Project Participants

Presenters: Heather Terbeek, Hank House, Cesar

Cardenas, and Rachel Sorris

Models: Becky Roark & Kevin Geiger

Researchers: Caitlin Wall, Heather Terbeek, Hank

House, Cesar Cardenas, and Becky Roark

Special Thanks to Our Faculty: Jeff Roberts,

Dr. Leamor Kahanov, and Chris Warden