Essentials of Regional Anesthesia Anatomy NYSORA - The New York School of Regional Anesthesia

14/7/2015 NYSORA
The New York School of Regional Anesthesia Essentials of Regional Anesthesia Anatomy
Essentials of Regional Anesthesia
Anatomy
By admin 19/09/2013 00:20:00
Authors: Admir Hadzic and Carlo Franco
A good practical knowledge of anatomy is important for the successful and safe practice of regional anesthesia. In
fact, just as surgical disciplines rely on surgical anatomy, regional anesthesiologists need to have a working knowl
edge of the anatomy of nerves and associated structures that does not include unnecessary details. In this chapter,
the basics of regional anesthesia anatomy necessary for successful implementation of various techniques described
later in the book are outlined.
Anatomy of Peripheral Nerves
All peripheral nerves are similar in structure. The neuron is the basic functional unit responsible for the conduction of
nerve impulses (Figure 1). Neurons are the longest cells in the body, many reaching a meter in length. Most neurons
areincapable of dividing under normal circumstances, and they have a very limited ability to repair themselves after
injury. A typical neuron consists of a cell body (soma) that contains a large nucleus. The cell body is attached to
several branching processes, called dendrites, and a single axon. Dendrites receive incoming messages; axons
conduct outgoing messages. Axons vary in length, and there is only one per neuron. In peripheral nerves, axons are
very long and slender. They are also called nerve fibers.
Connective Tissue
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14/7/2015 NYSORA The New York School of Regional Anesthesia Essentials of Regional Anesthesia Anatomy
Figure 1: Organization of the peripheral nerve
The individual nerve fibers that make up a

nerve, like individual wires in an electric cable,
are bundled together by connective tissue. The
connective tissue of a peripheral nerve is an
important part of the nerve. According to its
position in the nerve architecture, the
connective tissue is called the epineurium,
perineurium, or endoneurium (Figure 2). The
epineurium surrounds the entire nerve and holds
it loosely to the connective tissue through
which it runs. Each group of axons that bundles
together within a nerve forms a fascicle, which
is surrounded by perineurium. It is at this level
that the nerve–blood barrier is located and
constitutes the last protective barrier of the
nerve tissue. The endoneurium is the fine
connective tissue within a fascicle that Figure 2: Histology of the peripheral nerve and connective tissues.
surrounds every individual nerve fiber or axon. White arrows: External epineurium (epineural sheath), 1 = Internal
epineurium, 2 = fascicles, Blue arrows: Perineurium, Red arrow:
Nerves receive blood from the adjacent blood
Nerve vasculature Green arrow: Fascicular bundle.
vessels running along their course. These
feeding branches to larger nerves are
macroscopic and irregularly arranged, forming anastomoses to become longitudinally running vessel(s) that supply
the nerve and give off subsidiary branches.
Organization of the Spinal Nerves
The nervous system consists of central and peripheral parts. The central nervous system includes the brain and
spinal cord. The peripheral nervous system consists of the spinal, cranial, and autonomic nerves, and their
associated ganglia. Nerves are bundles of nerve fibers that lie outside the central nervous system and serve to
conduct electrical impulses from one region of the body to another. The nerves that make their exit through the skull
are known as cranial nerves, and there are 12 pairs of them. The nerves that exit below the skull and between the
vertebrae are called spinal nerves, and there are 31 pairs of them. Every spinal nerve has its regional number and
can be identified by its association with the adjacent vertebrae (Figure 3). In the cervical region, the first pair of
spinal nerves, C1, exits between the skull and the first cervical vertebra. For this reason, a cervical spinal nerve
takes its name from the vertebra below it. In other words, cervical nerve C2 precedes vertebra C2, and the same
system is used for the rest of the cervical series. The transition from this identification method occurs between the
last cervical and first thoracic vertebra. The spinal nerve lying between these two vertebrae has been designated C8.
Thus there are seven cervical vertebrae but eight cervical nerves. Spinal nerves caudal to the first thoracic vertebra
take their names from the vertebra immediately preceding them. For instance, the spinal nerve T1 emerges
immediately caudal to vertebra T1, spinal nerve T2 passes under vertebra T2 and so on.
Figure 3: Organization of the spinal nerve
Connective Tissue
Each spinal nerve is formed by a dorsal and a ventral root that come together at the level of the intervertebral fora
men (Figure 3). In the thoracic and lumbar levels, the first branch of the spinal nerve carries visceral motor fibers to
a nearby autonomic ganglion. Because preganglionic fibers are myelinated, they have a light color and are known as
white rami (Figure 4). Two groups of unmyelinated postganglionic fibers leave the ganglion. Those fibers innervating
glands and smooth muscle in the body wall or limbs form the gray ramus that rejoins the spinal nerve. The gray and
white rami are collectively called the rami communi cantes. Preganglionic or postganglionic fibers that inner vate
internal organs do not rejoin the spinal nerves. Instead, they form a series of separate autonomic nerves and serve
to regulate the activities of organs in the abdominal and pelvic cavities.
The dorsal ramus of each spinal nerve carries sensory innervation from, and motor innervation to, a specific
segment of the skin and muscles of the back. The region innervated resembles a horizontal band that begins at the
origin of the spinal nerve. The relatively larger ventral ramus supplies the ventrolateral body surface, structures in
the body wall, and the limbs. Each spinal nerve supplies a specific segment of the body surface, known as a
dermatome.
Dermatomes
A dermatome is an area of the skin supplied by the dorsal (sensory) root of the spinal nerve (Figures 5 and 6). In the
head and trunk, each segment is horizontally disposed, except C1, which does not have a sensory component.
Figure 4: Organization and function of the segmental (spinal nerve).
The dermatomes of the limbs from the fifth cervical to the first thoracic nerve, and from the third lumbar to the
second sacral vertebrae, form a more complicated arrangement due to rotation and growth during embryologic life.
There is considerable overlapping of adjacent dermatomes; that is, each segmental nerve overlaps the territories of
its neighbors. This pattern is variable among individuals, and it is more of a guide than a fixed map.
Figure 5: Dermatomes and corresponding peripheral Figure 6: Dermatomes and corresponding peripheral
nerves: front nerves: back.
Myotomes
A myotome is the segmental innervation of skeletal muscle by a ventral root of a specific spinal nerve (Figure 7).
Figure 7: Motor innervation of the major muscle groups. (A) Medial and lateral rotation of shoulder and hip. Abduction
and adduction of shoulder and hip. (B) Flexion and extension of elbow and wrist. (C) Pronation and supination of
forearm. (D) Flexion and extension of shoulder, hip, and knee. Dorsiflexion and plantar flexion of ankle, lateral views.
Osteotomes
The innervation of the bones follows its own pattern and does not coincide with the innervation of more superficial
structures (Figure 8).
Figure 8: Osteotomes
Nerve Plexuses
Although the dermatomal innervation of the trunk is simple, the innervation of the extremities, part of the neck, and
pelvis is highly complex. In these areas, the ventral rami of the spinal nerves form an intricate neural network; nerve
fibers coming from similar spinal segments easily reach different terminal nerves. The four major nerve plexuses are
the cervical plexus, brachial plexus, lumbar plexus, and sacral plexus.
The Cervical Plexus
The cervical plexus originates from the ventral rami of C1C5, which form three loops (Figures 9 and 10). Branches
from the cervical plexus provide sensory innervation of part of the scalp, neck, and upper shoulder and motor
innervation to some of the muscles of the neck, the thoracic cavity, and the skin (Table 1). The phrenic nerve, one
of the larger branches of the plexus, innervates the diaphragm.
Figure 9: Organization of the cervical plexus
Figure 10: Superficial cervical plexus branches. ct, transverse cervical; ga, greater auricular; lo, lesser occipital; sc,
supra clavicular. Also shown is the spinal accessory nerve (SA).
Table 1: Organization and Distribution of the Cervical Plexus
NERVES SPINAL SEGMENTS DISTRIBUTION
Five of the extrinsic laryngeal muscles
Ansa cervicalis (superior and
C1C4 (sternothyroid, sternohyoid, omohyoid,
inferior branches)
geniohyoid, and thyrohyoid) by way of N XII
Lesser occipital, transverse
cervical, supraclavicular, and C2C3 Skin of upper chest, shoulder, neck and ear
greater auricular nerves
Phrenic nerve C3C5 Diaphragm

Levator scapulae, scalene muscles,
Cervical nerves C1C5 sternocleidomastoid, and trapezius muscles
(with N XI)
The Brachial Plexus
The brachial plexus is both larger and more complex than the cervical plexus (Figures 11, 12, 13, 14A,B, 15A,B, and
16). It innervates the pectoral girdle and upper limb. The plexus is formed by five roots that originate from the ventral
rami of spinal nerves C5T1. The roots converge to form the superior (C5C6), middle (C7), and inferior (C8T1) trunks
(Table 2). The trunks give off three anterior and three posterior divisions as they approach the clavicle. The divisions
rearrange their fibers to form the lateral, medial, and posterior cords. The cords give off the terminal branches. The
lateral cord gives off the musculocutaneous nerve, and the lateral root of the median nerve. The medial cord gives off
the medial root of the median nerve and the ulnar nerve. The posterior cord gives off the axillary and radial nerves.
Figure 11: Organizatio of the brachial plexus
Figure 12: View of the posterior triangle of
Figure 13: The brachial plexus (in yellow) at the level of the trunks (U, M, and L)
the neck, located above the clavicle
occupies the smallest surface area in its entire trajectory. Also shown are the
between the sternocleidomastoid (SCM)
dome of the pleura (PL) in blue, the subclavian artery (SA) and the vertebral
in front and the trapezius (trap) behind. It
artery, both in red. The phrenic nerve, in yellow, is seen trav eling anterior to the
is crossed by the omohyoid muscle (OH)
anterior scalene muscle (AS).
and the brachial plexus (BP).
A B
Figure 14: (A) A thick fascia layer (sheath) covers the brachial plexus in the posterior triangle. Also seen is part of the
sternocleidomastoid muscle (SCM), the cervical transverse vessels (CT), and the omohyoid muscle (OH). (B) Once
the sheath is removed, the brachial plexus can be seen between the anterior scalene (AS) and middle scalene (MS)
muscles.
Figure 15: (A) In the axilla the brachial plexus is also surrounded by a thick fibrous fascia that here is shown partially open
with a metal probe inside. The musculocutaneous nerve can be seen exiting the sheath and entering the coracobrachialis
muscle. (B) The sheath has been open. Pectoralis minor (pec minor) has been partially resected. The takeoff of the
musculocutaneous nerve from the lateral cord (LC) inside the sheath is clearly visible.
Figure 16: Intercostobrachial nerve (T2) is the lateral branch of the second intercostal nerve that supplies sensory
innerva tion to the axilla and upper medial side of the arm.
Table 2: Organization and Distribution of the Brachial Plexus
SPINAL
NERVES DISTRIBUTION
SEGMENTS
Nerves to subclavius C4C6 Subclacious muscle
Dorsal scapular nerve C5 Rhomboid muscles and levator scapulae muscle
Long thoracic nerve C5C7 Serratus anterior muscle
Suprascapular nerve C5, C6 Supraspinatus and infraspinatus muscle
Pectoralis nerve
C5T1 Pectoralis muscle
(median and lateral)
Subscapular nerves C5, C6 Subscapularis and teres major muscles
Thoracodorsal nerve C6C8 Latissimus dorsi muscle
Axillary nerve C5, C6 Deltoid and teres minor muscles, part of skin of shoulder
Extensor muscle of the arm and forearm (triceps brachii,
extensor carpi radialis, and extensor carpi ulnaris muscles)
Radial nerve C5T1 and brachioradialis muscle; digital extensors, and abductor
pollicis muscle; skin over the posterolateral surface of the
arm.
Flexor muscles on the arm (biceps brachii, brachialis, and
Musculocutaneous
C5C7 coracobrachialis muscles); skin over lateral surface of
nerve
forearm
Flexor muscles on the forearm (flexor carpi radialis and
palmaris longus muscles); pronator quadratus and pronator
Median nerve C6T1 teres muscles; digital flexors (through the palmar
interosseous nerve); skin over anterolateral surface of
hand
Flexor carpi ulnaris muscle, adductor pollicis muscle and
Ulnar nerve C8, T1
small digital muscles; skin over medial surface of the hand
The Lumbar Plexus
The lumbar plexus is formed by the ventral rami of spinal nerves L1L3 and the superior branch of L4 (Figures 17,
18A,B, and 19). In about 50% of the cases, there is a contribution from T12. The inferior branch of L4, along with the
entire ventral rami of L5, forms the lumbosacral trunk that contributes to the sacral plexus. Because the branches of
both the lumbar and sacral plexuses are distributed to the lower limb, they are often collectively referred to as the
lumbosacral plexus. The main branches of the lumbar plexus are the iliohypogastric, ilioinguinal, genitofemoral,
lateral femoral cutaneous, obturator, and femoral nerves (Figures 19, 20A,B; Table 3).
Figure 17: Intercostobrachial nerve (T2) is the lateral branch of the second intercostal nerve that supplies sensory
innerva tion to the axilla and upper medial side of the arm.
A B
Figure 18: (A) Posterior view of the back to show the thoracolumbar fascia (TLF), whose posterior layer has been
open as a small window through which part of the erector spinae muscles has been resected to show the anterior
layer of the thoracolumbar fascia. (B) One step further in the dissection shows part of the quadratus lumborum
muscle.
Figure 19: Two branches of the lumbar plexus, the femoral nerve and obturator, are seen between the quadratus
lumborum and psoas muscles in the right retroperitoneal space.
Table 3: Organization and Distribution of the Lumbar Plexus
NERVE(S) SPINAL SEGMENTS DISTRIBUTION
Abdominal muscles (external and internal oblique
Iliohypogastric nerve T12L1 muscles, transverse abdominis muscles); skin over
inferior abdomen and buttocks
Abdominal muscles (with iliohypogastric nerve);
Ilioinguinal nerve Li skin over superior, medial thigh, and portions of
external genitalia
Skin over anteromedial surface of thigh and
Genitofemoral nerve L1, L2
portions over genitalia
Lateral femoral Skin over anterior, lateral, and posterior surfaces
L2, L3
cutaneous nerve of thigh
Anterior muscles of thigh (sartorius muscle and
quadriceps group); adductor of thigh (pectineus
Femoral nerve L2L4 and iliopsoas muscles); skin over anteromedial
surface of thigh, as well as the medial surface of
leg, and foot through the saphenous nerve
Adductors of thigh (adductors magnus, brevis, and
longus); gracilis muscle; skin over medial surface
Obturator nerve L2L4 of thigh. Note: Writing about a branch of a branch
of the lumbar plexus may pro duce some
confusion.
A B
Figure 20:(A) Frontal view of the upper anterior thigh showing the inguinal ligament and some branches of the lumbar
plexus: FN, femoral nerve; GF, femoral branch of genitofemoral nerve; LF, lateral femoral cutaneous nerve; OB,
obturator nerve. The femoral vein (V) and artery (A) are also shown. (B) The same nerves of (A) are shown from the
lateral side.
The Sacral Plexus
The sacral plexus arises from the lumbosacral trunk (L4L5) plus the ventral rami of S1S4 (Figures 21, 22A,B, 23,
and 24). The main nerves of the sacral plexus are the sciatic nerve and the pudendal nerve (Table 4). The sciatic
nerve leaves the pelvis through the greater sciatic foramen to enter the gluteal area where it travels between the
greater trochanter and ischial tuberosity. In the proximal thigh it lies behind the lesser trochanter of the femur
covered superficially by the long head of the biceps femoris muscle. As it approaches the popliteal fossa, the two
components of the sciatic nerve diverge into two recognizable nerves: the common peroneal and the tibial nerve
(Figures 25 and 26).
Figure 21: Organization of the sacral plexus
A B
Figure 22: (A) The back and paraspinal muscles have been removed to show the transverse processes of the last
lumbar vertebra, the psoas muscle, and the femoral nerve. (B) Same as (A) showing that the lateral edge of the
psoas muscle at the iliac crest is between 4 and 5 cm from the midline. fem, femoral.
Figure 23: Dissection of the right gluteal area demon strates Figure 24:The sciatic nerve (SN) from the gluteal area to the
that the inferior border of the gluteus maximus does not subgluteal fold is located about 10 cm from the midline in
correspond superficially with the subgluteal fold; instead both adults. This distance is not affected by gender or body
cross each other diagonally. habitus.
Table 4: Organization and Distribution of the Sacral Plexus
SPINAL
NERVE(S) DISTRIBUTION
SEGMENTS
Gluteal nerves Abductors of thigh (gluteus minimus, gluteus medius, and
L4S2
Superior Inferior tensor fasciae latae); extensor of thigh (gluteus maximus)
Posterior femoral
S1S3 Skin of perineum and posterior surface of thigh and leg
cutaneous nerve
Two of the hamstrings. Note: All three hamstrings are
innervated by the sciatic nerve (only motor nerve of the
Sciatic nerve L4S3 posterior thigh), especially the long head of biceps
(semitendinosus and semimembranosus); adductor magnus
(with obturator nerve)
Flexor of knee and plantar flexors of ankle (popliteal,
gastrocnemius, soleus, and tibialis posterior muscles and long
Tibioal nerve L4S3
head triceps of biceps femoris mus cle); flexors of toes; skin
over posterior surface of leg, plantar surface of foot
Biceps femoris muscle (short head); peroneus (brevis and
Common peroneal longus), and tibi alis anterior muscles; extensors of toes, skin
L4S3
nerve over anterior surface of leg and dorsal surface of foot; skin over
lateral portion of foot (through the sural nerve)
Muscles of perineum, including urogenital diaphragm and
external anal and urethral sphincter muscles; skin of external
Pudendal nerve S2S4
genitalia and related skeletal muscles (bulbospongiosus,
ischiocavernosus muscles)
Figure 25: Both components of the sciatic nerve, common peroneal (CP) and tibial (T) nerves diverge from each
other at the popliteal fossa. Lateral and medial gastrocne mius muscles (GN) are also shown.
Figure 26: The sural nerve is shown behind the lateral malleolus.
Thoracic and Abdominal Wall
Thoracic Wall
The intercostal nerves originate from the ventral rami of the first 11 thoracic spinal nerves. Each intercostal nerve
becomes part of the neurovascular bundle of the rib and provides sensory and motor innervations (Figure 27).
Except for the first, each intercostal nerve gives off a lateral cutaneous branch that pierces the overlying muscle
near the midaxillary line. This cutaneous nerve divides into anterior and posterior branches, which supply the
adjacent skin. The intercostal nerves of the second to the sixth spaces reach the anterior thoracic wall and pierce
the superficial fascia near the lateral border of the sternum and divide into medial and lateral cutaneous branches.
Most of the fibers of the anterior ramus of the first thoracic spinal nerve join the brachial plexus for distribution to the
upper limb. The small first intercostal nerve is in itself the lateral branch and supplies only the muscles of the
intercostal space, not the overlying skin. The lower five intercostal nerves abandon the intercostal space at the
costal margin to supply the muscles and skin of the abdominal wall.
Anterior Abdominal Wall
The skin, muscles and parietal peritoneum, or the anterior abdominal wall, are innervated by the lower six thoracic
nerves and the first lumbar nerve. At the costal margin, the seventh to eleventh thoracic nerves leave their
intercostal spaces and enter the abdominal wall in a fascial plane between the transversus abdominis and internal
oblique muscles. The seventh and eighth intercostal nerves slope upward following the contour of the costal margin,
the ninth runs horizontally, and the tenth and eleventh have a somewhat downward trajectory. Anteriorly, the nerves
pierce the rectus abdominis muscle and the anterior layer of the rectus sheath to emerge as anterior cutaneous
branches that supply the overlying skin.
The subcostal nerve (T12) takes the line of the twelfth rib across the posterior abdominal wall. It continues around
the flank and terminates in a similar manner to the lower intercostal nerves. The seventh to twelfth thoracic nerves
give off lateral cutaneous nerves that further divide into anterior and posterior branches. The anterior branches
supply the skin as far forward as the lateral edge of rectus abdominis. The posterior branches supply the skin
overlying the latissimus dorsi. The lateral cutaneous branch of the subcostal nerve is distributed to the skin on the
side of the buttock.
Figure 27: Organization of the segmental spinal nerve, intercostal nerve, and innervations of the chest wall.
The inferior part of the abdominal wall is supplied by the iliohypogastric and ilioinguinal nerves, both branches of
L1.The iliohypogastric nerve divides, runs above the iliac crest, and splits into two terminal branches. The lateral
cutaneous branch supplies the side of the buttock; the anterior cutaneous branch supplies the suprapubic region.
The ilioinguinal nerve leaves the intermuscular plane by piercing the internal oblique muscle above the iliac crest. It
continues between the two oblique muscles eventually to enter the inguinal canal through the spermatic cord.
Emerging from the superficial inguinal ring, it gives cutaneous branches to the skin on the medial side of the root of
the thigh, the proximal part of the penis, and the front of the scrotum in males and the mons pubis and the anterior
part of the labium majus in females.
Nerve Supply to the Peritoneum
The parietal peritoneum of the abdominal wall is innervated by the lower thoracic and first lumbar nerves. The lower
thoracic nerves also innervate the peritoneum that covers the periphery of the diaphragm. Inflammation of the
peritoneum gives rise to pain in the lower thoracic wall and abdominal wall. By contrast, the peritoneum on the
central part of the diaphragm receives sensory branches from the phrenic nerves (C3, C4, and C5), and irritation in
this area may produce pain referred to region of the shoulder (the fourth cervical dermatome).
Innervation of the Major Joints
Because much of the practice of peripheral nerve blocks involves orthopedic surgery, it is important to review the
innervation of the major joints to have a better understanding of the nerves involved for a more rational approach to
regional anesthesia.
Shoulder Joint
Innervation to the shoulder joints originates mostly from the axillary and suprascapular nerves, both of which can be
blocked by an interscalene block (Figure28).
Elbow Joint
Nerve supply to the elbow joint includes branches of all major nerves of the brachial plexus: musculocutaneous,
radial, median, and ulnar nerves.
Hip Joint
Nerves to the hip joint include the nerve to the rectus femoris from the femoral nerve, branches from the anterior
division of the obturator nerve, and the nerve to the quadratus femoris from the sacral plexus (Figure 29).
Knee Joint
The knee joint is innervated anteriorly by branches from the femoral nerve. On its medial side it receives branches
from the posterior division of the obturator nerve while both divisions of the sciatic nerve supply its posterior side
(Figure 30).
Ankle Joint
The innervation of the ankle joint is complex and involves the terminal branches of the common peroneal (deep and
superficial peroneal nerves), tibial (posterior tibial nerve), and femoral nerves (saphenous nerve). A more simplistic
view is that the entire innervation of the ankle joint stems from the sciatic nerve, with the exception of the skin on
the medial aspect around the medial malleolus (saphenous nerve, a branch of the femoral nerve) (Figure 31).
Wrist Joint
The wrist joint and joints in the hand are innervated by most of the terminal branches of the brachial plexus including
the radial, median, and ulnar nerves (Figure 32).
Figure 28: Innervation of the shoulder joint
Figure 29:Innervation of the hip joint
Figure 30: Innervation of the knee joint.
Figure 31: Innervation of the ankle joint and foot
Figure 32: Innervation of the wrist and hand
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14/7/2015 NYSORA

The individual nerve fibers that make up a

NERVES SPINAL SEGMENTS DISTRIBUTION

Phrenic nerve C3C5 Diaphragm

Nerves to subclavius C4C6 Subclacious muscle

Dorsal scapular nerve C5 Rhomboid muscles and levator scapulae muscle

Long thoracic nerve C5C7 Serratus anterior muscle

Suprascapular nerve C5, C6 Supraspinatus and infraspinatus muscle

Subscapular nerves C5, C6 Subscapularis and teres major muscles

Thoracodorsal nerve C6C8 Latissimus dorsi muscle

Axillary nerve C5, C6 Deltoid and teres minor muscles, part of skin of shoulder

NERVE(S) SPINAL SEGMENTS DISTRIBUTION

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Essentials of Regional Anesthesia Anatomy NYSORA - The New York School of Regional Anesthesia

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Essentials of Regional Anesthesia Anatomy NYSORA - The New York School of Regional Anesthesia

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Essentials of Regional Anesthesia Anatomy NYSORA - The New York School of Regional Anesthesia

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14/7/2015 NYSORA

The individual nerve fibers that make up a

NERVES SPINAL SEGMENTS DISTRIBUTION

Phrenic nerve C3­C5 Diaphragm

Nerves to subclavius C4­C6 Subclacious muscle

Dorsal scapular nerve C5 Rhomboid muscles and levator scapulae muscle

Long thoracic nerve C5­C7 Serratus anterior muscle

Suprascapular nerve C5, C6 Supraspinatus and infraspinatus muscle

Subscapular nerves C5, C6 Subscapularis and teres major muscles

Thoracodorsal nerve C6­C8 Latissimus dorsi muscle

Axillary nerve C5, C6 Deltoid and teres minor muscles, part of skin of shoulder

NERVE(S) SPINAL SEGMENTS DISTRIBUTION

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Phrenic nerve C3C5 Diaphragm

Nerves to subclavius C4C6 Subclacious muscle

Long thoracic nerve C5C7 Serratus anterior muscle

Thoracodorsal nerve C6C8 Latissimus dorsi muscle