Brachial Plexus Injuries

Question 1

Superior Trunk (C5 & C6)

Answer 1

• Result from excessive, forceful increase in angle between neck
and shoulder

• “waiter’s tip” position of limb
• Erb-Duchenne Palsy (Erb’s Palsy)

• paralysis of deltoid, biceps, brachialis,
brachioradialis

• Presents as adducted shoulder, with medially rotated arm and
extended elbow (upper limb hangs at side).

• Patient will be weak or unable to abduct arm, laterally rotate arm,
or flex elbow joint.

Question 2

Injuries to Inferior Trunk (C8 & T1)

Answer 2

• Occur when limb is suddenly and/or forcefully pulled in a superior
direction

• Klumpke’s Paralysis

• “claw-hand”
(claw-like position of
first and second digits)

Question 3

Injuries to the Radial Nerve (C5-T1)

Answer 3

• Can occur with mid-shaft fractures of the humerus
• Improper use of crutches
• Extensors compartments affected
• “Wrist drop”

• “Saturday Night Palsy” (nerve gets pinched due to certain
sleep position resulting in loss of ability to extend wrist & digits)

• Paresthesia and/or pain along course of nerve

Question 4

Injuries to the Axillary Nerve (C5, C6)

Answer 4

• Can occur with fractures to the surgical neck of the humerus or
dislocation of the glenohumeral joint.

• Improper use of backpack (Quadrangular Space Syndrome; can
also involve compression of posterior circumflex humeral artery).

• Can result in impaired or lost function of deltoid and teres major

• Patient would be unable to fully abduct their arm, and may have
a diminished ability to laterally rotate arm.

• Paresthesia and/or pain with along course of nerve

Question 5

Injuries to the Long Thoracic Nerve (C5, C6, C7)

Answer 5

• This nerve can be damaged during surgical removal of lymph
nodes or other tissues in the axillary region.

• Penetrating trauma to the axillary region can also damage
this nerve

• Serratus Anterior is affected
• “winged scapula”, inability to raise arms past 90o

Question 6

Injuries to the Ulnar Nerve (C8, T1, and often C7)

Answer 6

• Fracture of medial epicondyle of humerus can damage this
nerve. Fracture of proximal ulna may also result in damage.

• Slashed wrist (medial side)

• Damage will involve flexors of wrist, digits, and intrinsic
hand muscles.

radial deviation at wrist joint, loss of ab- and adduction of
fingers, weak wrist flexion and some loss of flexion of digits

• losses depend on where nerve is damaged

Question 7

Injuries to the Median Nerve (C6-T1)

Answer 7

• Can be injured by fracture of the humerus above the condyles,
slashing of the wrist, or by inflammation or irritation in the carpal
tunnel (Carpal Tunnel Syndrome).

• Flexors of wrist and digits affected, also intrinsic hand muscles,
particularly those that move digit 1 (thumb).

• “Pope’s Blessing” (when making a fist, unable to flex second
and third digits)

• “Ape Hand” (thenar eminence atrophy and loss of thenar
opposition)