Brachial Plexus Flashcards

1
Q

List the principles of nerve transfer

A
  • Donor: should be expendable
  • Donor: should be close to end-organ target
  • Donor: should be synergistic/easy to relearn
  • Tension free coaptation – donor distal, recipient proximal
  • Motor nerve transfer should be end to end

sensory nerve transfer : end-to-end if critical sensation, end to side if non-critical sensation

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2
Q

What features differentiate a preganglionic from postganglionic BP injury

A

Preganglionic = root avulsion (proximal to DRG)

Postganglionic = nerve rupture/neuroma in continuity

Evaluation Technique

Supraganglionic Lesion

Infraganglionic Lesion

Inspection

Flail arm, winged scapula, Horner’s syndrome

Flail arm

Manual muscle testing

Paralysis of serratus anterior, rhomboids +/- diaphragm and limb musculature

Paralysis of limb

Head Position

2o denervation of paraspinous muscle

Normal

Sensation

Absent

Absent

Pain

Deafferentation pain

Lower incidence

Horner’s Syndrome

C8 & T1 Avulsion

Traction injury very close to cord

Tinel’s sign

Absent

Present (unless supraganglionic lesions are present at the same level)

Histamine Triple Test

Vasodilation, wheal & flair

Absent

CT/Myelography

Traumatic pseudomeningoceles, obliteration of root detail

Normal

Electromyography

Paravertebral muscle and limb muscle denervation

Limb Muscle denervation

Nerve conduction

Motor conduction absent, sensory present

Motor and Sensory conduction absent

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3
Q

List the nerve transfers to restore Elbow flexion

A

Donor: UN fascicle of FCU + MN fascicle of FCR/PL/FDS OR Medial Pectoral n, Intercostal, Td, Distal Accessory

Recipient: Biceps brachii, branchialis OR musculocutaneous

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4
Q

List the nerve transfers to restore Elbow Extension

A

Donor: UN fascicle to FCU, Intercostal

Recipient: Triceps RN

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5
Q

List the nerve transfers to restore Shoulder Abduction and external rotation

A

Donor: SAN, Pectoral fascicle of C7

Recipient: Suprascapular N

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6
Q

List the nerve transfers to restore Shoulder Abduction

A

Donor: Intercostals, Medial Pectoral branch, Medial Triceps branch, Td

Recipient: Axillary n

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7
Q

List the nerve transfers to correct scapular winging

A

Donor: Td, pectoral fascicle of C7

Recipient: LTN

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8
Q

Classify nerve injury

A

Seddon

Sunderland

Pathology

Structure involved

Recovery pattern

Rate of recovery

Neurapraxia

I

Local conduction block

Gross structures intact

Complete

Fast

Days to weeks

Axonotmesis

II

Axons undergo Wallerian degeneration

Complete

Slow 1mm/day

III

Axon, myelin & endoneurium

Varies depending on endoneurial scarring

Slow 1 mm/day

IV

Axon, myelin, endoneurium & perineurium

Incomplete recovery, neuroma-in-continuity

Nerve Repair or graft

Neurotmesis

V

Transection of nerve

All (inc epineurium)

None

Nerve repair or graft

MacKinnon

VI

Mixed Injury

Components of all the above

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9
Q

How do you classify brachial Plexus injury

A

By nerve injury type

  • Root avulsion
  • Nerve rupture
  • Neuroma-in-continuity

By location

  • preganglioninc
  • postganglionic

By anatomical structures involved

  • roots, trunk, division, cords, branches
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10
Q

Describe the MRC muscle grading system

A

Muscle Grading

Observation

0

No contraction

1

Flicker or trace f contraction

2

Active movement, with gravity eliminated

3

Active movement, against gravity

4

Active movement against gravity and resistance

5

Normal power

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11
Q

Describe Erb-Duchenne Palsy

A

= injury to C5-C6 roots or upper trunk

  • Muscles affected: rhomboid, levator scapulae (C5), deltoid, serratus anterior, supraspinatus, infraspinatus, biceps, branchialis, coracobranchialis, brachioradialis, radial wrist extensors, clavicular head of pectoralis
  • Functional loss: shoulder abduction, external rotation, elbow flexion, wrist extension
  • Sensory loss: lateral arm and thumb/index
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12
Q

Describe Erb’s plus deformity

A

= injury to C5,6,7

  • Muscles affected: as in erb duchenne + triceps, ECRL, ECRB, EDC EPL EPB APL
  • Functional loss: as in erb duchenne + loss of elbow, wrist, finger extension
  • Sensory loss: thumb, index and long fingers
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13
Q

Describe Klumpke palsy

A

= injury to C(7),8,T1

  • muscles affected: FPL, FDP, FDS, (EDC/EPL), lumbrical, inteross, hypothenar, thenar
  • functional loss: finger and thumb flexion, (thumb finger extension)
  • sensory loss: anterior and medial arm, ring and little fingers
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14
Q
A
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