The fifth cervical ventral spinal rami leave the vertebral column above the transverse processes of C5 and emerge between scalenus anterior and scalenus medius, deep to the internal jugular vein and the sternocleidomastoid muscle.

Before joining with the ventral rami of C6 to form the upper trunks of the brachial plexus, the fifth cervical ventral spinal rami give rise to the dorsal scapular nerves, branches which join with branches of the ventral rami of C3 and C4 to form the phrenic nerves, and branches which join with branches of the ventral rami of C6 and C7 to form the long thoracic nerves.  From the upper trunks of the brachial plexuses the nerves to subclavius and the suprascapular nerves arise.

Each ramus receives at least one grey ramus communicans from the middle cervical ganglion.  

Supply
The fifth cervical ventral spinal rami supply the longus colli, scalenus anterior, scalenus medius, rhomboideus major and minor, serratus anterior, subclavius, supraspinatus and infraspinatus muscles and muscles of the upper limb via the brachial plexus.  Cutaneous branches to the upper limb are also distributed via the brachial plexus.