Cervical plexus

The cervical plexus is a conglomeration of cervical nerves formed by the anterior (ventral) rami of spinal nerves
C1-C4 (a.k.a. 1st-4th cervical nerves). These are the roots (limbs) of the cervical plexus. The 5th cervical
nerve (i.e., the anterior ramus of spinal nerve C5) may also be considered as part of the plexus due to its
contribution in the formation of one of the motor branches of the cervical plexus, the phrenic nerve. Therefore, the
cervical plexus can also be defined as a network of nerves formed by the anterior rami of spinal nerves C1 – C5
that gives off both motor (deep) and sensory (superficial) branches.

Key facts about the cervical plexus

Sensory Branches Lesser occipital nerve, Great auricular nerve, Transverse cervical

nerve, Supraclavicular nerves
Mnemonic: Let's Go To Sleep

Motor Branches Muscular branches (to sternocleidomastoid, prevertebral and levator

scapulae), Ansa Cervicalis, Phrenic nerve
Mnemonic: MAP

Innervation Lesser occipital nerve: skin of the neck and the scalp posterosuperior
to the clavicle
Great auricular nerve: skin over the parotid gland, the posterior aspect
of the auricle, and an area of skin extending from the angle of the
mandible to the mastoid process
Transverse cervical nerve: skin covering the anterior triangle of the
neck
Supraclavicular nerves: skin over the neck and shoulder
Ansa cervicalis: infrahyoid muscles
Phrenic nerve: diaphragm, mediastinal pleura, pericardium of the heart 

The cervical plexus is formed in the neck region. It lies deep to the sternocleidomastoid muscle, and
anterolateral to the levator scapulae. Each of the cervical nerves forming the plexus communicates with one
another in a superior-inferior fashion close to their origins, thus C2 accepts communicating fibres from C1, C3
from C2, and so on. These communicating fibres are the contributions from the sympathetic trunk (sympathetic
nervous system) to the cervical plexus and are known as the “Gray rami” communicates (meaning blood vessel
accompanied). They descend from the superior cervical ganglion (which is the largest of the three cervical
ganglia).
Each of the cervical nerves (except the first, C1) then divide into two branches: an ascending branch and
a descending branch. They subsequently unite with branches of adjacent cervical nerves to form loops. Loops
and branches from the cervical nerves contribute to the formation of the cervical plexus.

Branches
Sensory
Branches of the cervical plexus include motor branches supplying muscles, and cutaneous branches innervating
the skin of the anterolateral neck, the superior part of the thorax (superolateral thoracic wall) and scalp between
the auricle (pinna) and the external occipital protuberance.
The sensory (posterior or cutaneous) branches of the plexus emerge around the middle of the posterior border
of the sternocleidomastoid muscle. This area is clinically significant and recognized as the nerve point of the
neck.
There are four sensory branches originating from the two loops formed between the anterior rami of spinal
nerves C2 and C3, and C3 and C4. These are:

 Branches from the loop between C2 and C3:

o Lesser occipital nerve (formed by C2)
o Great auricular nerve (formed by C2 and C3)
o Transverse cervical nerve (formed by C2 and C3)
 Branches from the loop between C3 and C4:
o Supraclavicular nerves (formed by C3 and C4)
As highlighted in the names of those four sensory branches, a mnemonic to memorize the names can be derived
from the bolded letters. Thus, the mnemonic for the sensory branches is Let's Go to Sleep.
Motor
On the other hand, the motor branches of the cervical plexus form the ansa cervicalis (C1-C3), which is a nerve
loop innervating the infrahyoid muscles in the anterior cervical triangle. 
They also form the phrenic nerve (C3-C5) which supplies the diaphragm and the pericardium of the heart.
Additional muscular branches are also given off to provide innervation to several prevertebral,
sternocleidomastoid and trapezius muscles. 

 Ansa cervicalis (mnemonic: Susan Saw Game Of Thrones)
o Sternohyoid nerve (C1 – C3)
o Sternothyroid nerve (C1 – C3)
o Geniohyoid nerve (via hypoglossal nerve) (C1)
o Omohyoid nerve (C1 – C3)
o Thyrohyoid nerve (via hypoglossal nerve) (C1)
 Phrenic nerve (contributed mainly by C4, with little fibres from C3 and C5)
 Muscular branches to prevertebral, sternocleidomastoid and levator scapulae muscles 
You can easily remember the motor branches of cervical plexus by using the mnemonic MAP (Muscular
branches, Ansa cervicalis, Phrenic nerve)
Find out more about the cervical plexus using the following study unit:

Course and distribution

Sensory branches

 Lesser occipital nerve: This branch is formed by the second cervical nerve (C2) only, and courses to
supply the skin of the neck and the scalp posterosuperior to the clavicle.
 Great auricular nerve: This sensory branch originates from the C2 and C3 nerves. It courses upwards in
a diagonal fashion and crosses the sternocleidomastoid muscle onto the parotid gland. It then divides
and innervates the skin over the parotid gland, the posterior aspect of the auricle, and an area of skin
extending from the angle of the mandible to the mastoid process.
 Transverse cervical nerve: The transverse cervical nerve is formed by axons from the second and third
cervical nerves. It supplies the skin covering the anterior triangle of the neck. This branch curves around
the middle of the posterior border of the sternocleidomastoid muscle and crosses it deep to the platysma
muscle.
 Supraclavicular nerves: These branches are formed by the C3 and C4 spinal nerves, and emerge as a
common trunk under cover of the sternocleidomastoid muscle. This divides into three smaller branches
(medial, intermediate and lateral) to the skin of the neck. Some branches also cross the clavicle to
supply the skin over the shoulder.
Motor branches

 The ansa cervicalis: The five motor branches of the ansa cervicalis loop listed above, originate from C1
to C3 nerves. The ansa cervicalis is formed by two roots, superior and inferior, which are formed by the
fibers from the anterior rami of the cervical spinal nerves. They supply the infrahyoid muscles in the
anterior cervical triangle.
 The phrenic nerve: The phrenic nerve originates chiefly from the 4th cervical nerve (C4) but receives
contributions from the 3rd and 5th cervical nerves (C3 and C5). It is formed at the superior part of the
lateral border of the anterior scalene muscle, at the level of the superior border of the thyroid cartilage.
The phrenic nerve contains motor, sensory, and sympathetic nerve fibres. It provides the sole motor
supply to the diaphragm as well as sensation to its central part. In the thorax, the phrenic nerve
innervates the mediastinal pleura and pericardium of the heart. The phrenic nerve descends obliquely
across the anterior scalenus muscle, deep to the prevertebral layer of deep cervical fascia and the
transverse cervical and suprascapular arteries. It runs posterior to the subclavian vein and anterior to
the internal thoracic artery as it enters the thorax.
Clinical notes

Phrenic nerve severance

Severance (injury) of the phrenic nerve results in paralysis of the diaphragm. Temporary paralysis of the diaphragm
can also result from phrenic nerve block. In this condition, the anaesthetic is injected around the nerve where it lies
on the anterior surface of the middle third of the anterior scalene muscle. A surgical phrenic nerve crush will
produce a longer period of paralysis (for example, for weeks after surgical repair of a diaphragmatic hernia).

Cervical plexus block

Nerve block is a measure to inhibit nerve impulse conductance, usually for regional anaesthesia prior to surgical
operations. In a cervical plexus block, an anaesthetic agent is injected at several points along the posterior border of
the sternocleidomastoid muscle, mainly at the junction of its superior and middle thirds - the nerve point of the
neck. Because the phrenic nerve supplying the diaphragm pericardium is also paralysed by cervical plexus block, this
procedure is not performed on patients with pulmonary or cardiac disease.
Overview of the cervical plexus