Brachial Plexus and Nerve Lesions Flashcards
What does Randy Travis Drinks Cold Beer mean?
Roots Trunks Divisions Cords Branches
Spinal levels in upper trunk
C5-C6
Spinal levels in Middle Trunk
C7
Spinal levels in Lower Trunk
C8-T1
Spinal levels in posterior cord
C5-T1
Spinal levels in musculocutaneous nerve
C5-C7
Spinal levels in Median nerve
C5-T1
Spinal levels in Ulnar nerve
C8-T1
What nerves branch off the posterior cord?
axillary and radial
Injury to upper trunk.
Erb palsy (waiter’s tip)
Injury to lower trunk
Klumpke palsy (claw hand)
Injury to posterior cord
Wrist drop
Injury to Axillary nerve
Deltoid paralysis
Injury to Radial nerve
“Saturday night palsy” (wrist drop)
Injury to Musculocutaneous Nerve
Problems flexing elbow
Damage to median nerve
“Pope’s blessing” (decreased thumb function)
Damage to Ulnar nerve
Claw hand
Damage to long thoracic nerve
winged scapula
What causes “waiter’s tip” in Erb palsy?
Deficits in:
- Deltoid/supraspinatus (so arm is ADDucted)
- Infraspinatus (so arm is MEDIALY rotated)
- Biceps brachii (arm extended and pronated)
What injuries cause Klumpke palsy?
- Infants (upward force on arm during delivery)
- Adults (grabbing tree branch while falling)
What causes the claw hand in Klumpke palsy?
deficits in intrinsic hand muscles (no lumbricles, so MCPs are extended and DIPs/PIPs are flexed)
What injuries cause thoracic outlet syndrome?
-Pancoast tumor
What is the deficit in thoracic outlet syndrome?
compression of lower trunk and subclavian vessels (give same deficits as Klumpke palsy with atrophy of intrinsic hand muscles and pain from vascular compression)
What injury leads to Winged scapula?
- Axillary node dissection after mastectomy
- Stab wounds
Why does your scapula “wing” with thoracic nerve injury?
Inability of the serratus anterior to anchor scapula to thoracic cage (and cannot abduct arm above horizontal plane)
What injuries affect the axillary nerve?
- Fractured surgical neck of humerus
- Anterior dislocation of humerus
What is the presentation of axillary nerve lesion?
- Flat deltoid
- Loss of abduction at shoulder (>15 degrees)
- Loss of sensation over deltoid and lateral arm
What is the presentation of musculocutaneous nerve damage?
- Loss of forearm flexion and supination
- Loss of sensation over lateral forearm
What injuries cause radial nerve damage?
- Midshaft fracture of huemrus
- Compression of axilla (crutches or sleeping with arm over chair)
What is the presentation of radial nerve damage?
- Wrist drop (lose all extension past elbow)
- Decrease grip strength
- Loss of sensation over posterior arm/forearm and dorsal hand
What injuries cause median nerve damage?
- Supracondylar fracture of humerus (proximal lesion)
- Carpal tunnel syndrome and wrist laceration (distal lesion)
What is the presentation of median nerve damage?
- Ape hand (lose thumb opposition, and flexion of wrist and lateral fingers)
- Lose sensation over thenar eminence and dorsal/palmar aspects of lateral 3.5 fingers
What injuries cause ulnar nerve injury?
- Fracture of medial epicondyle of humerus (funny bone)
- Fractured hook of hamate
What is the presentation of ulnar nerve injury?
- Claw on digit extension
- Radial deviation of wrist on flexing (proximal lesion)
- Loss of flexion of wrist and medial fingers; abduction/adduction of fingers, actions of medial 2 lumbrical muscles
- Loss of sensation of medial 1.5 fingers and hypothenar eminence
What causes injury to the recurrent branch of the medial nerve?
-Superficial laceration of palm
What is the presentation of injury to recurrent branch of median nerve?
- Ape hand
- No loss of sensation
What cervical levels are in the axillary nerve?
C5-C6
What cervical levels are in the ulnar nerve?
C8-T1
Spinal levels for obturator
L2-L4
Spinal levels for femoral
L2-L4
Spinal levels for common peroneal
L4-S2
Spinal levels for tibial
L4-S3
Spinal levels for superior gluteal
L4-S1
Spinal levels for inferior gluteal
L5-S2
Cause of obturator injury
pelvic surgery
Presentation of obturator injury
- Poor adduction
- Loss of medial thigh sensation
Cause of femoral nerve injury
pelvic fracture
Presentation of femoral nerve injury
-Poor thigh flexion and leg extension
Cause of common peroneal nerve injury
- Compression of lateral leg aspect
- Fibular neck fracture
Presentation of common peroneal nerve injury
- Food drop (plantar flexed and inverted)
- Steppage gait
- Loss of dorsal foot sensation
Cause of tibial nerve injury
- Knee trauma
- Baker cyst (proximal)
- Tarsal tunnel syndrome (distal)
Presentation of tibial nerve injury
- Inability to curl toes
- Loss of sensation to sole of foot
- (Proximal lesion)- foot everted and dorsiflexed
Cause of superior gluteal nerve injury
- Posterior hip dislocation
- Shot in superior medial butt
- Polio
Presentation of superior gluteal nerve injury
-Trendelenburg sign/gait (contralateral hip drop when patient putting weight on side that is injured)
Cause of inferior gluteal nerve injury
Posterior hip dislocation
Presentation of inferior gluteal nerve injury
- Difficulty climbing stairs or rising from seat
- Loss of hip extension
PED TIP
Peroneal Everts & Dorsiflexes
Tibial Inverts and Plantarflexes
Levels of sciatic nerve
L4-S3
What does the sciatic nerve split into?
- Common peroneal nerve
- Tibial nerve
Artery running with long thoracic at axilla/lateral thorax
Lateral thoracic
Artery running with axillary nerve at surgical neck of humerus
Posterior circumflex
Artery running with radial nerve at midshaft of humerus
Deep brachial
Artery running with median nerve at distal humerus/cubital fossa
Brachial
Artery running with tibial nerve through popliteal fossa
Popliteal
Artery running with tibial nerve posterior to medial malleolus
posterior tibial
