Brachial plexus injuries Flashcards
Prevalence of Complete lesions : involving all the roots of the Brachial plexus ?
Rare
Complications of a Complete lesion ; involving all the roots of the Brachial plexus ?
-Result in complete paralysis of all limb muscles except (Trapezius)
- Complete loss of sensation except : (on upper half of deltoid) and (floor of axilla)
Erb Duchenne palsy ?
Upper trunk lesion of the Brachial plexus ; at erb’s point C5,C6
Name the common Brachial plexus injury ; that is a complication of brachial plexus stretching during delivery
Upper trunk lesion : Erb Duchenne palsy
Nerves affected in : Erb Duchenne palsy ?
-Nerve to subclavius
-Suprascapular nerve
-Axillary nerve
-Musculocutaneous nerve
Presentation of Erb Duchenne palsy ?
The limb is adducted, medially rotated and pronated:
”waiter ’s tip” deformity ;
+loss of sensation down the lateral side of the arm.
Name the Brachial plexus injury : associated with excessive abduction or traction of arm
Lower trunk lesion : Klumpke’ s paralysis
Brachial roots affected in Klumpke’ s paralysis ?
C8 and T1
Paralysis associated with “Klumpke’ s paralysis” ?
-Paralysis of interossei and lumbricals
-Paralysis of flexor carpi ulnaris ;
-and ulnar half of flexor digitorum profundus
Major presentation of Klumpke’ s paralysis ?
-Claw hand and ;
-Horner syndrome (T1 affection)
A common cause of : Suprascapular nerve lesion ?
(Not plexus related)
Entrapment
Complications of Suprascapular nerve lesion ?
-Wasting
-Weakened abduction and lateral rotation
Causes of : Long thoracic nerve lesion ?
-During mastectomy
-Carrying heavy object on shoulder
-Chest tube insertion
-Stab wound
Complications of : Long thoracic nerve lesion ?
-Winging of scapula
-Difficulty raising arm above shoulder
Name the condition , and the nerve injury associated with it
Shoulder dislocation ;
- Axillary nerve palsy
Two major causes : of Axillary nerve palsy ?
-Surgical neck fracture of the humerus
-Shoulder dislocation
Presentation of Axillary nerve palsy ?
-Wasting of deltoid
-Weakened abduction
Causes of Median nerve injury at elbow ?
-Supracondylar fracture
-Entrapment (Struther ’s ligament)
Define the lesion and the nerve injury associated with it
Supracondylar fracture ;
- Median nerve injury
Define the lesion and the nerve injury associated with it
Entrapment by (Struther ’s ligament) ;
- Median nerve injury
Motor complications of : Median nerve injury at elbow ?
-Hand of benediction
-Ape hand deformity
-Loss of pronation and weak wrist
Sensory complications associated with : Median nerve injury at elbow ?
Causes of Median nerve injury at wrist ?
- Colle’s fracture
-Stab wound
Define the condition and the nerve injury associated
Colle’s fracture ;
- Median nerve injury at wrist
Define the condition and the nerve injury associated
Carpal tunnel syndrome
Major causes of Carpal tunnel syndrome ?
•arthritic changes (arthritis)
•tenosynovitis
•Carpal dislocation
•diabetes
•thyroid dysfunction
•fluid retention from pregnancy
A common occupational cause of : Carpal tunnel syndrome ?
Typing :
Presentation of Carpal tunnel syndrome ?
- burning pain or “pins and needles” followed by sensory loss
- weakness and flattening
Treatment of Carpal tunnel syndrome ?
The condition is dramatically relieved by decompressing the tunnel making a longitudinal incision through the flexor retinaculum
….. is a nerve of no cutaneous or motor branches in the axilla or in the arm
The ULNAR NERVE
Root value of ulnar nerve ?
• The ulnar nerve arises from the medial cord of the brachial plexus (C7, C8 and T1)
Causes of : Ulnar Nerve lesion at elbow ?
-Supracondylar fracture
-Medial epicondyle fracture
-Entrapment (cubital tunnel)
Paralysis associated with : Ulnar Nerve lesion at elbow ?
- Flexor carpi ulnaris: week flexion of wrist with radial deviation
- Medial ½ of flexor digitorum profundus: no flexion at distal interphalyngeal joints of 4 th and 5 th finger
- Hypothenar muscles: atrophy
- Interossei
- Adductor pollicic: loss of adduction of thumb
Motor presentation of Ulnar Nerve lesion at elbow ?
-Incomplete claw hand ;
+flattening of hypothenar eminence
+hollowing between metacarpal bones due to wasting
Sensory loss associated with : Ulnar Nerve lesion at elbow ?
Sensory loss:
-Palmar cutaneous branch
-Palmar digital branch
-Dorsal cutaneous branch
Vasomotor changes associated with : Ulnar Nerve lesion at elbow ?
loss of sympathetic control»_space; warm, dry skin
Trophic changes associated with : Ulnar Nerve lesion at elbow ?
dry, scaly, atrophy of pulp, cracking nails
Causes of : Ulnar Nerve lesion at wrist ?
Cut and Stab wound (Guyon’s canal)
Motor affection associated with : Ulnar Nerve lesion at wrist ?
Same as lesion at elbow ,, but forearm muscles are spared
Compare between the severity of deformity seen in : Ulnar nerve injury at elbow/vs/ at wrist
Worse at wrist
Why is the incomplete claw hand worse in ulnar nerve injury at wrist ?
due to contraction of distal interphalangeal joints of 4 th and 5 th digits
Sensory loss associated with : Ulnar Nerve lesion at wrist ?
Same except dorsal aspect of palm and proximal phalanges are spared
Summarize ulnar nerve injury at elbow
1- Weak flexion
2- Loss of wrist adduction
3- Inability to adduct thumb
4- Inability to put the hand in writing position
- Sensory loss
- Partial claw hand deformity
Summarize ulnar nerve injury above wrist
1- No Weak flexion
2- No Loss of adduction
3- Inability to adduct thumb
4- Inability to put the hand in writing position
- Sensory loss to fingers only
- Partial claw hand deformity is more prominent (Ulnar paradox)
Common causes of Radial nerve injury at axilla ?
Complications of Radial nerve injury at axilla ?
Two causes of Radial nerve injury at spiral groove ?
- Humeral fractures at spiral groove
- Posterior interosseous nerve entrapment
Name the hidden structure and mention the condition in which it can be injured
Posterior interosseous nerve entrapment»_space; proximal radial nerve injury
