Nerve guide notes

• The brachial plexus gives rise to the nerves of the upper limb

  
• Roots of the brachial plexus

  Ventral rami of C5, C6, C7, C8 and T1

  
• Trunks

  Formed by the roots, each divide into anterior and posterior divisions
• Cords

  Formed by the union of the divisions, pass into the axilla
• Terminal nerves

  Five nerves given off from the cords that travel down the upper limb

  
• Nerves branching directly off roots, trunks and cords

  • Dorsal scapular nerve (C5)
  • Long thoracic nerve (C5, 6, 7)
  • Nerve to subclavius (C(4), 5, 6)
  • Suprascapular nerve (C(4), 5, 6)
  • Medial pectoral nerve (C8, T1)
  • Medial cutaneous nerves of arm and forearm (C8, T1)
  • Upper subscapular nerve (C(4), 5, 6, (7))
  • Lower subscapular nerve (C5, 6)
  • Thoracodorsal nerve (C(6), 7, 8)
  • Lateral pectoral nerve (C5, 6, 7)

  
• Lateral (recurrent) branch of median nerve

  Passes laterally and proximally to supply muscles of thenar eminence

  
• Lateral (recurrent) branch of median nerve

  • Motor supply: Abductor pollicis, FPB, OPB and 1st lumbrical
  • Sensory supply: Skin on adjacent sides of thumb and index finger

  
• Medial branch of median nerve

  Divides into several palmar digital nerves, passing through palm deep to palmar aponeurosis but superficial to long flexor tendons

  
• Medial branch of median nerve

  • Motor supply: 2nd lumbrical
  • Sensory supply: Palmar surface of lateral 3 1/2 digits, dorsal aspect of distal phalanges of lateral 3 1/2 digits, articular branches to MCP and IP joints

  
• Anterior interosseous nerve

  Arises from median nerve in cubital fossa, descends forearm on anterior surface of interosseous membrane between FPL and FDP

  
• Anterior interosseous nerve

  • Motor supply: FPL, lateral ½ of FDP and pronator quadratus
  • Sensory supply: Articular branches to radiocarpal and intercarpal joints

  
• Palmar cutaneous branch of median nerve

  Arises from median nerve in distal 1/3 of forearm, runs superficially down forearm and passes over flexor retinaculum to enter palm

  
• Palmar cutaneous branch of median nerve

  • Motor supply: None
  • Sensory supply: Skin on lateral side of palm and thenar eminence

  
• Superficial branch of ulnar nerve

  Lies deep to palmaris brevis on medial side of hand

  
• Superficial branch of ulnar nerve

  • Motor supply: Palmaris brevis
  • Sensory supply: Skin on medial third of palm, palmar surface of medial 1½ digits, dorsal aspect of distal phalanges of medial 1½ digits

  
• Deep branch of ulnar nerve

  Follows path of deep palmar arch to cross to lateral side of palm

  
• Deep branch of ulnar nerve

  • Motor supply: FDM, abductor digiti minimi, ODM, dorsal and palmar interossei, adductor pollicis and medial 2 lumbricals
  • Sensory supply: Articular branches to wrist joint

  
• Dorsal branch of ulnar nerve

  Arises from ulnar nerve in distal 1/3 of forearm, passes backwards deep to FCU to become superficial on medial side of wrist
• Dorsal branch of ulnar nerve


  • Motor supply: None
  • Sensory supply: Skin on dorsal surface of medial side of hand and dorsal surfaces of medial 1½ digits

  
• Palmar cutaneous branch of ulnar nerve


  Arises from ulnar nerve in distal 1/3 of forearm, descends through forearm superficially and passes over flexor retinaculum

  
• Palmar cutaneous branch of ulnar nerve

  • Motor supply: None
  • Sensory supply: Skin on medial side of palm

  
• Deep branch (posterior interosseous nerve) of radial nerve


  1. Begins in front of lateral epicondyle of humerus, enters posterior compartment of forearm by curving around lateral and posterior surfaces of radius, passing between 2 heads of supinator

  2. Descends between deep and superficial extensor muscles

  3. In lower forearm lies on posterior aspect of interosseous membrane and terminates at wrist

  
• Deep branch (posterior interosseous nerve) of radial nerve


  • Motor supply: Supinator, ECRB, ED, EDM, ECU, EPL, EI, abductor pollicis longus and EPB
  • Sensory supply: Articular branches to intercarpal joints