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 Athletic Trainers
Divisions Drink
Cords Cold
Branches Beer
Brachial Plexus Branches &
Muscular Innervations
Dorsal Scapular N. Suprascapular N.
Levator Scapulae Infraspinatus
Rhomboid Major/Minor Supraspinatus
Lateral Pectoral N. Musculocutaneous N.
Pectoralis Major/Minor Biceps Brachii
Brachialis
Coracobrachialis
Brachial Plexus Branches &
Muscular Innervations
Axillary N. Middle Subscapular or
Deltoid Thoracodorsal N.
Teres Minor Latissimus Dorsi
Upper Subscapular N. Lower Subscapular N.
Subscapularis Subscapularis
Teres Major
Brachial Plexus Branches &
Muscular Innervations
Median N. Radial N.
Abductor Pollicis Abductor Pollicis Brevis
Brevis/Longus Anconeus
Flexor Carpi Radialis Brachioradialis
Flexor Digitorum Extensor Carpi Radialis
Superficialis Brevis/Longus
Flexor Digitorum Profundus Extensor Carpi Ulnaris
(Lat. 2) Extensor Digiti Minimi
Flexor Pollicis Brevis (Lat.) Extensor Digitorum
& Longus Communis
Lumbricales (Lat. 2) Extensor Indicis
Opponens Pollicis Extensor Pollicis
Palmaris Longus Brevis/Longus
Pronator Quadratus Supinator
Pronator Teres * Triceps Brachii
Brachial Plexus Branches &
Muscular Innervations
Ulnar N. Long Thoracic N.
Abductor Digiti Minimi Serratus Anterior
Adductor Pollicis
Dorsal Interossei Medial Pectoral N.
Flexor Carpi Ulnaris Pectoralis Major
Flexor Digiti Minimi
Flexor Digitorum
Profundus (Med. 2)
Medial Brachial
Cutaneous N. (sensory)
Flexor Pollicis Brevis
(Med.)
Lumbricals (Med. 2) Medial Antebrachial
Opponens Digiti Minimi Cutaneous N. (sensory)
Palmar Interossei
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 Erb’s 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 patient’s 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 nerve’s 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. Musculocutaneous N.
• Sensory – Lateral • Sensory – Anterior
arm arm
• Motor – Shoulder • Motor – Elbow
abduction flexion
Peripheral Nerve Tests
Radial N. Median N.
• Sensory – 1st Dorsal • Sensory – Pad of
web space Index finger
• Motor – Wrist • Motor – Thumb pinch
extension and thumb and abduction
extension
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 Thoracic Outlet Syndrome
• Cervical Compression • Adson’s Test
Test
• Allen’s Test
• Cervical Distraction
Test
• Military Brace Position
• Spurling’s Test
• Brachial Plexus
Traction Test
References
Duralde, X. A. (2000). Neurologic injuries in athlete’s 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
