NerveAnatomyFunctionRisk factors for injury
AxillaryFrom brachial plexus, around humeral head, through the quadrilateral space to deltoid/teres minor
Quadrilateral space boundaries: humeral neck, teres major and minor, long head of triceps
Motor: deltoid, teres minor
Sensory: skin over lower half of the deltoid
Humeral head compresses nerve during extreme abduction
Upward pressure through the axilla
Shoulder dislocation
Compression in quadrilateral space
Long thoracicC5 to C7 merge, travel between clavicle and first rib through axilla to serratus anterior muscle
Long nerve: 20 to 22 cm
Motor: serratus anterior
Sensory: none
Sudden upper extremity traction
Shoulder depression with contralateral neck flexion
Prolonged compression (backpacker's palsy)
MedianBrachial plexus down anterior arm, at antecubital fossa passes through radial tunnel, dives between two heads of pronator muscle, under flexor digitorum superficialis, through carpal tunnelMotor:
Injury at elbow or forearm: Weak wrist flexion, no interphalangeal flexion of thumb, index, and long digit
Injury at wrist: none or weak thumb abduction
Sensory:
Injury at elbow: proximal forearm pain
Injury at wrist: sensory loss in the thumb, radial 2.5 digits, and thenar eminence
Injury at elbow or forearm: radial tunnel, within pronator teres muscle, under flexor digitorum superficialis
Injury at wrist: carpal tunnel syndrome
MusculocutaneousC5 to C7 merge into lateral cord brachial plexus, goes through axilla, under coracobrachialis, through biceps and under deep fascia at the elbowMotor:
Injury at shoulder: loss in biceps, coracobrachialis, and brachialis
Injury at elbow: none
Sensory: radial side of forearm (dorsal and volar), but not hand
Shoulder dislocation
Hypertrophy of the coracobrachialis
Deep brachial fascia of elbow as nerve exits biceps (sensory symptoms only)
RadialFrom brachial plexus, through axilla, down posterior arm until it circles toward anterior arm at spiral groove of the humerus; down anterior arm and enters radial tunnel just above the lateral epicondyle
Divides into superficial and deep (posterior interosseus nerve) branches
Motor:
Injury in axilla: loss of elbow flexion; weak wrist and digit extension; weak forearm supination
Injury at elbow: superficial branch (radial tunnel): forearm pain, normal motor; posterior interosseus nerve: weak or no wrist extension
Injury at wrist: no motor loss
Sensory: variable sensory loss in distal forearm or hand
Injury at elbow: no sensory loss; possible pain with repetitive forearm supination
Injury in axilla or proximal humerus (fracture)
Injury at elbow: radial tunnel or area of proximal radius (fracture or dislocation); two nerve branches from elbow have injury potential, posterior interosseus nerve has mostly motor loss and the superficial branch has only sensory change (pain)
Spinal accessoryEmerges through sternocleidomastoid muscle, across posterior neck, dives under trapeziusMotor: trapezius
Sensory: none
Very superficial course in posterior neck and directly under the trapezius muscle
SuprascapularFrom upper trunk brachial plexus, through posterior triangle, across top of scapula and through scapular notch, down posterior aspect scapula and across scapular spine to supraspinatus, infraspinatusMotor: supraspinatus, infraspinatus
Sensory: acromioclavicular and glenohumeral joints
Entrapment under transverse scapular ligament that covers the suprascapular notch
Injury as it crosses scapular spine or under spinoglenoid ligament
UlnarFrom brachial plexus down anterior arm; just above medial epicondyle it passes to the posterior compartment and into the cubital tunnel; down ulnar side of forearm into Guyon canal (boundaries are hamate and pisiform bones); splits into deep (motor) and superficial (sensory) branches in canalMotor: no loss or weak thumb adduction, weak digit abduction, and adduction toward center of long digit
Sensory:
Injury at elbow: pain ulnar side of forearm with or without paresthesias in ulnar digits
Injury at wrist: paresthesias in ulnar digits
Injury at elbow or forearm: cubital tunnel, ulnar nerve irritation with medial collateral ligament deficiency
Injury at wrist: Guyon canal
Upper trunk cervical plexusNerve roots C5 and C6 as they exit vertebral foramina and form upper trunk brachial plexusMotor: infraspinatus, supraspinatus, biceps, and deltoid
Sensory: C5 and C6 dermatomes
No protective coverings (epineurium and perineurium) on the nerves after they exit the foramina
Increased risk of stretch injury at neck and shoulder regions
Contusion or compression of upper trunk at Erb point