INTRODUCTION AND BACKGROUND
The brachial plexus is a network of nerve fusions and divisions that originate from cervical and upper thoracic nerve roots and terminate as named nerves that innervate muscles and skin of the shoulder and arm. Although detailed knowledge of the elements of the network is important for distinguishing between radiculopathy and mononeuropathy, a syndromic approach is more useful for diagnosing lesions involving the plexus itself.
This topic will briefly review the underlying anatomy, pathogenesis, and general clinical features of brachial plexopathies, and then discuss a number of specific brachial plexopathies, classified for convenience by clinical setting into traumatic, nontraumatic, iatrogenic, and neonatal types.
Anatomy — Nerve roots from C5 through T1 contribute to the brachial plexus (figure 1). The plexus can be divided into regions that include (from proximal to distal) trunks, divisions, cords, branches, and nerves. Trunks and divisions are further subdivided with a nomenclature based on overall relationships with other upper extremity anatomic structures and include upper, lower, and middle trunks, and posterior, lateral, and medial cords.
●C5 and C6 roots merge to form the upper trunk. The C7 root forms the middle trunk. C8 and T1 roots merge to form the lower trunk.
●The upper trunk divides and gives branches to the lateral and posterior cords. The middle trunk divides and gives branches to the lateral and posterior cords. The lower trunk divides and gives branches to the posterior and medial cord.