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The Brachial Plexus

The Brachial Plexus in the Cervical Region (supine with neck turned to opposite side)

The brachial plexus emerges between the scalene muscles in the neck and joins the subclavian artery as it lies above the first rib. The tapering lateral edge of the sternocleidomastoid muscle lies over the brachial plexus. The brachial plexus and scalene muscles are covered by the prevertebral fascia. In contrast to more peripheral nerves, the cervical roots (ventral rami) often have a monofascicular appearance.

 
 
   
 

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The Brachial Plexus above the First Rib

The brachial plexus can be identified just superficial and lateral to the subclavian artery in the neck. The brachial plexus can be traced between the scalene muscles and more cephalad to show higher cervical roots. The interconnections of the brachial plexus can sometimes be identified using short axis slides (Video 1.1 MB).

In some subjects the cephalad elements of the brachial plexus (such as the C5 and/or C6 ventral rami) pass through or over the anterior scalene muscle rather than between the anterior and middle scalene muscles (Video 2.6 MB).

 
 
   
 

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References

Sheppard DG, Iyer RB, Fenstermacher MJ. Brachial plexus: demonstration at US. Radiology. 1998 Aug;208(2):402-6. PMID: 9680567

Yang WT, Chui PT, Metreweli C. Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus. AJR Am J Roentgenol. 1998 Dec;171(6):1631-6. PMID: 9843302

Martinoli C, Bianchi S, Santacroce E, Pugliese F, Graif M, Derchi LE. Brachial plexus sonography: a technique for assessing the root level. AJR Am J Roentgenol. 2002 Sep;179(3):699-702. PMID: 12185049

Demondion X, Herbinet P, Boutry N, Fontaine C, Francke JP, Cotten A. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol. 2003 Aug;24(7):1303-9. PMID: 12917117

Harry WG, Bennett JD, Guha SC. Scalene muscles and the brachial plexus: anatomical variations and their clinical significance. Clin Anat. 1997;10(4):250-2. PMID: 9213042