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Lateral cord

The lateral cord is one of the three terminal branches, or cords, of the brachial plexus, a network of nerves originating from the ventral rami of spinal nerves C5 through T1 that innervates the upper limb.^[1] It forms in the axilla by the union of the anterior divisions of the superior trunk (C5–C6) and the middle trunk (C7), positioning it lateral to the axillary artery.^[1] This cord is essential for motor and sensory functions in the anterior upper arm and lateral forearm.^[2] The lateral cord gives rise to three main branches: the lateral pectoral nerve, the musculocutaneous nerve, and the lateral root of the median nerve.^[1] The lateral pectoral nerve (C5–C7) emerges as a nonterminal branch, piercing the clavipectoral fascia to innervate the pectoralis major muscle, contributing to shoulder and arm flexion.^[1] The musculocutaneous nerve (C5–C7) is a primary terminal branch that supplies motor innervation to the coracobrachialis, biceps brachii, and brachialis muscles for elbow flexion and supination, while its continuation as the lateral antebrachial cutaneous nerve provides sensory innervation to the lateral forearm skin.^[3] The lateral root of the median nerve (C6–C7) joins the medial root from the medial cord to form the median nerve, which primarily innervates forearm flexors and provides sensation to the lateral palm and digits.^[2] Anatomically, the lateral cord lies superficial to the axillary artery and vein in the axilla, surrounded by axillary fat and lymph nodes, making it vulnerable during surgical procedures like axillary lymph node dissection.^[1] Injuries to the lateral cord, often from trauma, compression, or iatrogenic causes, can result in weakness of elbow flexion, forearm supination, and sensory deficits in the lateral forearm, potentially mimicking isolated musculocutaneous nerve lesions.^[4] Variations in its formation or branching occur in approximately 4% of cases, such as anomalous communications with other cords, which may complicate regional anesthesia or increase risks in upper limb surgeries.^[5]

Anatomy

Formation and origin

The brachial plexus originates from the ventral rami of spinal nerves C5 through T1, which unite to form three trunks: the upper trunk from C5 and C6, the middle trunk from C7, and the lower trunk from C8 and T1.^[1] Each trunk subsequently divides into anterior and posterior divisions, with the anterior divisions supplying flexor compartments and the posterior divisions innervating extensor compartments of the upper limb.^[1] The lateral cord specifically arises from the convergence of the anterior division of the upper trunk and the anterior division of the middle trunk, positioning it laterally to the axillary artery in the infraclavicular region.^[1] This formation reflects the lateral cord's primary contribution from spinal segments C5, C6, and C7, with the upper trunk providing fibers from C5 and C6, and the middle trunk contributing those from C7.^[1] The union occurs distal to the trunks' divisions, establishing the cord's role in the brachial plexus hierarchy as a key intermediary structure for anterior division fibers destined for the anterior arm and forearm regions.^[1] Embryologically, the lateral cord develops during the innervation of the upper limb bud, beginning around the fifth week of gestation when axons from the ventral rami of C5-C7 extend as a single radicular cone into the limb mesenchyme.^[6] By weeks 5 to 8, these fibers differentiate into ventral and dorsal divisions, with the anterior (ventral) components from the upper and middle trunks coalescing to form the lateral cord, coinciding with the maturation of motor fibers from basal plate cells and sensory fibers from neural crest derivatives.^[6]^[1] This segmental organization ensures targeted innervation of the developing upper limb's flexor groups.^[6]

Course and relations

The lateral cord of the brachial plexus descends obliquely through the axilla, extending from the lateral border of the first rib toward the coracoid process, where it lies posterior to the pectoralis minor muscle.^[7]^[8] It is oriented superolaterally relative to the axillary artery, passing across its first part in close proximity.^[10] In the axilla, the lateral cord is positioned superior to the medial cord and posterior to the clavicle, forming part of the neurovascular bundle with the subclavian and axillary vessels.^[7]^[11] It lies adjacent to the short head of the biceps brachii anteriorly and is superficial to the axillary artery while deep to the clavipectoral fascia.^[8]^[12]

Branches

The lateral cord of the brachial plexus gives rise to three main branches: the lateral pectoral nerve, the musculocutaneous nerve, and the lateral root of the median nerve.^[1] The lateral pectoral nerve arises proximally, near the formation of the lateral cord in the axilla, and is composed of fibers from spinal levels C5 to C7.^[1] This small nerve pierces the clavipectoral fascia to reach its target.^[13] The musculocutaneous nerve emerges as a terminal branch from the lateral cord, typically midway along its course, and carries fibers from C5 to C7.^[1] After providing innervation to muscles in the arm, it continues distally as the lateral cutaneous nerve of the forearm.^[1] The lateral root of the median nerve is the distalmost branch of the lateral cord, consisting of fibers primarily from C6 to C7, and extends medially as a short segment to fuse with the medial root, forming the median nerve lateral to the axillary artery.^[1]^[14] Anatomical variations in the branches of the lateral cord occur occasionally, including accessory branches, reported in approximately 10-15% of cases across cadaveric studies.^[15]

Function

Motor innervation

The lateral cord of the brachial plexus provides motor innervation primarily to muscles involved in flexion and supination of the upper limb through its key branches: the lateral pectoral nerve, the musculocutaneous nerve, and the lateral root of the median nerve.^[1] The lateral pectoral nerve arises from the lateral cord (C5-C7) and supplies the clavicular head of the pectoralis major muscle, facilitating adduction and medial rotation of the humerus at the shoulder joint.^[16] It also contributes to the innervation of the pectoralis minor muscle through an anastomosis with the medial pectoral nerve, aiding in scapular stabilization and protraction.^[17] The musculocutaneous nerve, a terminal branch of the lateral cord (C5-C7), innervates the anterior compartment muscles of the arm, including the coracobrachialis (which flexes and adducts the arm at the shoulder), biceps brachii (which flexes the elbow and supinates the forearm), and brachialis (the primary elbow flexor).^[3] The lateral root of the median nerve originates from the lateral cord (C6-C7) and joins the medial root to form the median nerve (C6-T1), which provides motor supply to the forearm flexors such as the pronator teres (for pronation), flexor carpi radialis (for wrist flexion and radial deviation), and flexor digitorum superficialis (for proximal phalangeal flexion), as well as the thenar muscles including the abductor pollicis brevis (thumb abduction), opponens pollicis (thumb opposition), and superficial head of flexor pollicis brevis (thumb flexion).^[18] Collectively, these contributions from the lateral cord enable flexion of the shoulder and elbow, supination of the forearm, pronation, wrist flexion, and fine thumb movements essential for upper limb function.^[1]

Sensory innervation

The lateral cord of the brachial plexus contributes sensory innervation to the upper limb primarily through its major branches, delivering general somatic afferent fibers responsible for touch, pain, and temperature sensation in the anterior aspect of the forearm and the lateral palm and digits. These sensory pathways originate from spinal levels C5–C7, with the musculocutaneous nerve and lateral root of the median nerve serving as the key conduits for cutaneous and deep sensations in these regions.^[19] The musculocutaneous nerve provides sensory supply to the lateral half of the forearm via its distal continuation as the lateral cutaneous nerve of the forearm. This nerve arises in the mid-arm, pierces the deep fascia near the elbow alongside the cephalic vein, and bifurcates into anterior and posterior branches that innervate the skin over the anterolateral forearm from the elbow crease to the wrist, covering approximately the radial half of the forearm's cutaneous surface. These fibers derive mainly from C5–C7 spinal roots and convey sensations of touch, pain, and temperature to this area.^[20]^[21] The lateral root of the median nerve contributes sensory fibers predominantly from C6–C7 levels, which unite with medial root fibers (C8–T1) to form the median nerve and support its extensive sensory distribution in the hand. This includes innervation of the palmar skin of the thumb, index finger, middle finger, and radial half of the ring finger, along with the corresponding nail beds and the dorsal skin over the distal phalanges of these digits up to the proximal interphalangeal joints. Additionally, the median nerve supplies deep sensory innervation to the joints of the wrist and carpus, facilitating proprioception and sensation from these structures.^[18]^[22] The lateral pectoral nerve, while primarily motor, may carry a minor component of proprioceptive and nociceptive fibers to the pectoralis major and minor muscles, contributing to deep sensation within these structures.^[23]

Clinical significance

Injuries and lesions

Injuries to the lateral cord of the brachial plexus typically arise from traumatic, compressive, or iatrogenic mechanisms. Trauma, such as shoulder dislocation, can stretch or avulse the infraclavicular portion of the plexus, leading to lateral cord involvement alongside other structures.^[24] Birth-related injuries, particularly Erb-Duchenne palsy from excessive traction on the neck during delivery, affect the C5-C6 roots and upper trunk (with extended forms including C7), thereby impacting the lateral cord's formation from their anterior divisions.^[25] Compression may occur in thoracic outlet syndrome, where anatomical anomalies or repetitive overhead activities impinge the cords against surrounding structures such as the pectoralis minor muscle.^[26] Iatrogenic damage is reported during axillary lymph node dissection for breast cancer, where surgical retraction or direct instrumentation risks the lateral cord's proximity to the axillary artery and vein.^[27] Clinical manifestations of lateral cord lesions primarily reflect deficits in its branches: the musculocutaneous nerve and the lateral root of the median nerve. Patients experience weakness or paralysis of elbow flexion (biceps and brachialis muscles) and loss of forearm supination, resulting in a pronated posture. Sensory loss affects the lateral forearm via the lateral antebrachial cutaneous nerve and the lateral palm, thumb, and index finger via the median nerve's lateral contribution, potentially causing paresthesia or numbness. Partial median nerve involvement may produce an incomplete ape-hand deformity, with thenar muscle weakness but preserved ulnar-innervated hand function. Additional signs include diminished biceps reflex (C5-C6) and possible vasomotor changes like skin dryness in chronic cases.^[28] Diagnosis relies on a combination of clinical examination, electrophysiological studies, and imaging. Electromyography (EMG) and nerve conduction studies identify C5-C7 denervation patterns, distinguishing conduction block from axonal loss in the musculocutaneous and median nerve distributions. Magnetic resonance imaging (MRI) visualizes plexus continuity, edema, or pseudocysts indicative of the lesion site. Provocative tests, such as the Adson maneuver for compression etiologies, and reflex assessment aid in localizing the lateral cord as the primary site.^[29] Prognosis depends on injury severity per Seddon classification: neuropraxia (conduction block without axonal disruption) often resolves spontaneously within weeks to months with conservative management like physical therapy. Axonotmesis (axonal disruption with intact endoneurium) allows regeneration at 1 mm/day but may require 3-12 months or surgical repair if no recovery by 3-6 months; neurotmesis (complete transection) typically necessitates grafting for any functional return. For severe cases without recovery, nerve transfer procedures, such as transferring branches from the median or ulnar nerves to the musculocutaneous nerve, have shown promising results in restoring elbow flexion as of studies up to 2025.^[30]^[31]^[32]

Surgical considerations

The lateral cord of the brachial plexus holds significant relevance in surgical procedures involving the axilla and shoulder region, particularly axillary lymph node dissection for breast cancer, where its branches such as the lateral pectoral nerve are at risk during removal of level I and II lymph nodes adjacent to the axillary artery. In brachial plexus exploration surgeries, the lateral cord is typically identified first below the pectoralis minor tendon, alongside the musculocutaneous nerve, to enable safe retraction and exposure of adjacent structures like the axillary artery and posterior cord. Shoulder surgeries, including arthroplasty and arthroscopic procedures near the coracoid process, also place the lateral cord at risk due to its close relation to the axillary artery and potential for traction during arm positioning or retractor use. Intraoperative risks to the lateral cord include transection during sharp dissection or stretch from arm abduction and external rotation, often resulting in neuropraxia with transient weakness in elbow flexion and forearm pronation. In shoulder arthroplasty, excessive arm extension or lateral traction has been linked to brachial plexopathy predominantly affecting the lateral cord, with women and patients undergoing extensive releases at higher risk for these neurapraxic injuries. Anesthesia considerations, such as interscalene brachial plexus block targeting C5-C7 roots that form the lateral cord, can induce temporary sensory and motor blockade but carry rare risks of persistent neuropraxia or phrenic nerve involvement if the injectate spreads excessively. Preservation of the lateral cord relies on anatomical landmarks, including its consistent position lateral to the axillary artery in the axilla, which guides identification and minimizes blind dissection during axillary or brachial plexus procedures. Intraoperative neuromonitoring with free-running electromyography (EMG) is utilized to detect real-time nerve irritation from surgical manipulation, enabling prompt adjustments to retractors or positioning to prevent traction injury. If intraoperative damage occurs, microsurgical repair involves primary neurorrhaphy for clean transections or nerve grafting—typically using sural nerve autografts—for defects, with interfascicular grafting preferred for gaps exceeding 3 cm to optimize axonal regeneration and functional recovery. Since the early 2000s, the rise of minimally invasive techniques in shoulder arthroscopy and axillary sentinel node biopsy has increased awareness of iatrogenic lateral cord injuries, prompting standardized protocols for nerve mapping and monitoring to reduce such complications in brachial plexus-related surgeries.

References

[1]
Anatomy, Head and Neck: Brachial Plexus - StatPearls - NCBI - NIH
The lateral cord gives rise to a single nonterminal branch, the lateral pectoral nerve, that contains the spinal levels of C5 to C7 and innervates the ...
[2]
Cords of the Brachial Plexus and Their Branches Positioned ... - NIH
Jul 18, 2024 · The brachial plexus is a complex network of nerve fibers composed of the ventral rami of spinal nerves that emerge from the fifth cervical to ...
[3]
Anatomy, Shoulder and Upper Limb, Musculocutaneous Nerve - NCBI
The musculocutaneous nerve is a terminal branch of the lateral cord of the brachial plexus that carries fibers of cervical spinal nerves five through seven ( ...
[4]
Unusual and Unique Variant Branches of Lateral Cord of Brachial ...
Lateral cord of the brachial plexus is formed in the axilla by the union of anterior divisions of upper and middle trunks and it lies on the lateral side of the ...
[5]
https://pmc.ncbi.nlm.nih.gov/articles/PMC10001373/
[6]
The Brachial Plexus - Sections - Branches - TeachMeAnatomy
### Summary of Lateral Cord Trajectory in the Axilla
[7]
Overview, Gross Anatomy, Blood Supply of the Brachial Plexus
Oct 28, 2024 · The brachial plexus is composed of five roots, three trunks, six divisions, three cords, and terminal branches, as seen in the image below.
[8]
Lateral Cord - an overview | ScienceDirect Topics
The lateral cord of the brachial plexus represents the confluence of the anterior divisions of the upper and middle trunks. The lateral pectoral nerve is the ...
[9]
Unusual Branching Pattern of the Lateral Cord of the Brachial ... - NIH
We report a rare formation of the lateral cord of the brachial plexus observed during the dissection of a 47-year-old male cadaver at the Department of Anatomy, ...
[10]
Brachial plexus: Anatomy, branches and mnemonics - Kenhub
The lateral cord gives rise to the lateral pectoral nerve. The medial cord gives rise to medial pectoral nerve, medial cutaneous nerve of the arm, and medial ...
[11]
Multiple unilateral variations in medial and lateral cords of brachial ...
Mar 13, 2014 · The length of the main trunk was 3 cm and it divided into two branches-a cranial branch (branch 1) entering the lower part of pectoralis minor ...
[12]
Variations in the Formation of the Median Nerve and Its Clinical ...
The median nerve is commonly formed by the fusion of two roots, ie, the lateral root arises from the lateral cord and the medial root from the medial cord.
[13]
A study of the formation and branching pattern of brachial plexus ...
Fusion of adjacent trunks was detected in 2 limbs (3.33%). Variations in branches of lateral cord were detected in 8 limbs (13.33%).
[14]
Anatomy, Thorax, Pectoralis Major Major - StatPearls - NCBI Bookshelf
The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the ...<|separator|>
[15]
Anatomy, Shoulder and Upper Limb, Median Nerve - StatPearls - NCBI
Aug 20, 2023 · The median nerve predominantly provides motor innervation to the flexor muscles of the forearm and hand. The median nerve also provides sensory ...
[16]
Lateral Cord of Brachial Plexus | Complete Anatomy - Elsevier
The lateral cord conveys both sensory and motor innervation. For sensory, it innervates anterior and lateral surfaces of the forearm, hand, and fingers.
[17]
The Musculocutaneous Nerve - Course - Motor - TeachMeAnatomy
Aug 11, 2025 · It continues into the forearm as the lateral cutaneous nerve and provides sensory innervation to the lateral aspect of the forearm. Note: The ...
[18]
Musculocutaneous Nerve - Peripheral Nerve Surgery
Sensory Distribution Innervated: Lateral antebrachial cutaneous. Innervation Route: C6, C7 → lateral cord → musculocutaneous nerve → coracobrachialis. C5, C6 → ...
[19]
Median nerve - Neuromuscular Home Page
Median nerve: Anatomy. Formed by. C5 to C7 roots from lateral cord of brachial plexus; C8 and T1 roots from medial cord of brachial plexus. Branches.
[20]
Lateral pectoral nerve | Radiology Reference Article | Radiopaedia.org
Jun 8, 2025 · The lateral pectoral nerve also carries nociceptive and proprioceptive fibers. Variant anatomy. The lateral pectoral may have two distinct ...
[21]
Brachial plexus injury after shoulder dislocation: a literature review
Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation.
[22]
Erb Palsy - StatPearls - NCBI Bookshelf
Apr 8, 2023 · Erb palsy, or Erb-Duchenne paralysis, is a paralysis of the arm caused by the injury to the upper group of the main nerves supplying it.
[23]
Thoracic Outlet Syndrome - StatPearls - NCBI Bookshelf - NIH
Thoracic outlet syndrome (TOS) manifests when pressures in the thoracic outlet increase to the point of impinging vessels or nerves.Missing: cord | Show results with:cord
[24]
Brachial plexus injury occurring during breast surgery - Ng - 1999
Dec 24, 2001 · A case of brachial plexus injury occurring during axillary dissection as part of breast conservative surgery for breast cancer is reported.
[25]
Brachial Plexus Injury - Physiopedia
The nerves of the brachial plexus are damaged due to the forced pull by the widening of the shoulder and neck. Traction occurs from severe movement and causes a ...
[26]
Brachial Plexus Injuries - StatPearls - NCBI Bookshelf
[6] Injuries to the brachial plexus cause substantial debility and long-lasting difficulties in activities of daily living.Continuing Education Activity · Treatment / Management · Differential Diagnosis
[27]
Traumatic Brachial Plexopathy | PM&R KnowledgeNow - AAPM&R
May 11, 2022 · As compared to axonotmesis or neurotmesis, neuropraxia has a much more favorable prognosis because the axons themselves are not injured.
[28]
Brachial Plexus Injuries - Trauma - Orthobullets
Oct 16, 2023 · Recovery of reconstructed plexus can take up to 3 years nerve regeneration occurs at speed of 1mm/day.<|control11|><|separator|>