The brachial plexus innervates the entire upper limb – except part of the skin of the upper half of the medial arm which is innervated by the intercostobrachial nerve

The intercostobrachial nerve is synonymous to the lateral cutaneous branch of the second intercostal nerve

The intercostobrachial nerve joins the medial cutaneous nerve of the arm to supply the skin of the upper half of the medial arm

Surgery and analgesia of the upper limb distal to the shoulder level

The ultrasound guided infraclavicular brachial plexus block is a basic level block

The infraclavicular block anaesthetizes the brachial plexus inside the axilla

The brachial plexus in the infraclavicular region consists of three cords (syn: fascicles): the lateral, the posterior, and the medial cord

They run in close relationship to the axillary artery

That is exploited for the purpose of the infraclavicular brachial plexus block

The cutaneous distribution of the ulnar nerve is only to the hand

The infraclavicular brachial plexus block covers all muscles of the upper limb distal to the shoulder:

The radial nerve innervates
– the elbow extensor muscles
– the wrist extensor muscles

The musculocutaneous nerve innervates the elbow flexor muscles

The ulnar nerve innervates the intrinsic muscles of the hand including the medial finger flexors

The median nerve innervates the wrist flexor muscles including the lateral finger flexors

The radial nerve innervates the skin on the extensor side of the upper limb

The infraclavicular brachial plexus block provides cutaneous anaesthesia of the entire upper limb

The radial nerve innervates the skin of the back of the brachium and the lateral hand

The musculocutaneous nerve innervates the skin of the lateral antebrachium

The ulnar nerve innervates the skin of the medial hand and fingers

The median nerve innervates the skin of the anterior part of the lateral hand and fingers and the distal dorsal part of the second and third finger

The skin of the medial arm and forearm is innervated by the medial cutaneous nerves of the arm and forearm. They are both derived from the medial cord of the brachial plexus and covered by the infraclavicular brachial plexus block

The infraclavicular brachial plexus block anaesthetize all the bones and joints of the upper limb distal to the shoulder:

– The axillary nerve innervates the head of the humerus

– The radial nerve innervates the arm, the elbow, the forearm, the hand and the
radial fingers

– The musculocutaneous nerve innervates the humerus

– The ulnar nerve innervates the elbow and the hand and the ulnar fingers

– The median nerve innervates the elbow and the forearm and the hand and the
radial fingers

The median nerve only innervates the skin on the hand

The infraclavicular block anaesthetises the brachial plexus at the level of the cords

The upper limb is innervated by nerves from the brachial plexus (BP). The BP is derived from five spinal nerve roots C5-T1

The superior trunk (ST) comes from C5 and C6. The middle trunk comes from C7 (MT). The inferior trunk (IT) comes from C8 and T1. The anterior branches from ST and MT unite to become the lateral cord. The anterior branch of IT is the medial cord. The three posterior branches of ST, MT and IT unite to become the posterior cord

The axillary nerve and the radial nerve come from the posterior cord. The musculocutaneous nerve and part of the median nerve come from the lateral cord. The ulnar nerve and part of the median nerve come from the medial cord. The medial cutaneous nerves of the arm and the forearm branches off the medial cord. The suprascapular and axillary nerves are not anaesthetised by the infraclavicular block