Preaxial Innervation

Two primary homeostatic ARPs are formed by two terminal branches: the lateral pectoral nerve, directly derived from the proximal lateral cord supplying the pectoralis major muscle, and the lateral antebrachial cutaneous nerve, derived from the muscular cutaneous nerve, which innervates the skin on the lateral elbow.

H17 Lateral Pectoral (Muscular)

As one of the small terminal branches of the lateral cord, the lateral pectoral nerve (arising from C5 to C7) pierces the clavipectoral fascia and enters the pectoralis major muscle at a spot about 4 to 5 cm inferior to the middle point of the clavicular bone.

An ARP is formed at this neuromuscular attachment, which is commonly needled for symptoms of the chest and upper back. The practitioner should be cautious when needling here because the lung is just below this point. The author uses specific techniques here to minimize risk. First, the pectoralis major muscle is palpated. Then one of two techniques is applied:

1. In thin patients, a 1.5-cm-long needle is inserted perpendicular to the skin, with care that the needle does not puncture the lung.

2. In patients with a well-developed pectoralis major muscle, a 4.0-cm-long needle is directed horizontally and inferiorly. The needle must stay outside the rib cage so as not to puncture the lung.

The author has developed an additional new method, electrical vacuum therapy, to replace needling any ARP when the risk of pneumothorax is high.

The lateral pectoral nerve sends a branch laterally to the medial pectoral nerve, which supplies the pectoralis minor muscle and forms another ARP. The lateral pectoral nerve is so named because it arises from the lateral cord of the brachial plexus. Note that the H17 lateral pectoral ARP is located medially on the pectoralis major muscle, whereas the medial pectoral nerve is on the pectoralis minor muscle lateral to the H17 lateral pectoral ARP.

H9 Lateral Antebrachial Cutaneous (Cutaneous)

This ARP is located at the lateral end of the skin crest at the elbow joint and is easy to detect when the forearm is flexed at a 90-degree angle (Fig. 8-17). The musculocutaneous nerve (arising from C5 to C7) from the lateral cord of the brachial plexus courses

Musculocutaneous nerve

Coracobrachial -

Biceps brachii

Lateral cutaneous nerve of forearm

Figure 8-17 The musculocutaneous nerve and its branch, the lateral antebrachial cutaneous nerve.

along the lateral side of the arm and pierces the deep fascia at the lateral edge of the cubital fossa to become the lateral antebrachial cutaneous nerve. An ARP is formed at the location where the nerve pierces the deep fascia.

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