brachial plexus

Question 1

branches from roots

Answer 1

• long thoracic

- dorsal scapular

Question 2

long thoracic

Answer 2

• c5-c7
• passes vertically down neck + medial wall axilla
• lies superficially to serratus anterior
• innervates serratus anterior

Question 3

dorsal scapular

Answer 3

• c5
• passes posteriorly + pierces middle scalene
• travels along medial border of scapula
• rhomboids, levator scapulae

Question 4

injury to long thoracic

Answer 4

• Susceptible to injury through direct trauma or stretch
• Blow to the ribs underneath an outstretched arm - Damaged during surgery for breast cancer
• Stab injuries
• Carrying heavy bags over the shoulder for a prolonged time

Symptoms

• A posterior shoulder or scapular burning type of pain may be reported
• A lesion of the nerve paralyses serratus anterior - Winged scapula
• Patient pushes an outstretched arm against a wall

C5,C6,C7 - RAISE YOUR WINGS UP TO HEAVEN - WINGED SCAPULA - LONG THORACIC NERVE ROOTS INNERVATE SERRATUS ANTERIOR

Question 5

branches from trunks

Answer 5

superior trunk only

nerve to subclavius
- passes anteroinferiorly to subclavian artery + vein

suprascapular

• passes laterally through posterior triangle of neck - through trapezius to spinous fossa - through suprascapular notch
• supraspinatus + infraspinatus

Question 6

suprascapular nerve injury

Answer 6

due to entrapment neuropathy in suprascapular notch:

• shoulder pain
• weakness/ wasting of infra/supraspinatus

Question 7

injuries

Answer 7

stretch/Neuropraxia/Praxis Injury

• nerves damaged but not torn - - Swelling/bruising/compression/over-stretching
• Most common type of injury
• 90 –100% return of function

Neuroma
- Scar tissue around injury prevents communication with muscle, thus impairing movement
May requires surgery for removal of scar tissue

Rupture
Nerves torn in 1 or more places, but not detached
Surgery may repair, damage usually permanent

Avulsion
Most serious brachial plexus injury
Nerve torn
Permanently damaging consequenc

Question 8

obstetrical brachial plexus injuries

Answer 8

Most brachial plexus injuries occur at birth
2-5/1000 births
Shoulder dystocia - Fetal head is delivered, but shoulders are trapped behind mothers pelvic bone
In many cases child will recover full function in 1st week of life
If no improvement in 1st 2 weeks, recovery not likely
Permanent impairment occurs in up to 25% of cases

Question 9

upper plexus palsy

Answer 9

Erb-duchenne palsy - waiter’s tip

tearing of roots c5 + c6

Question 10

lower plexus palsy

Answer 10

klumpke paralysis

tearing of T1 root