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Upper Limb Anatomy > Brachial Plexus Injuries > Flashcards

Brachial Plexus Injuries Flashcards

1
Q

What is an avulsion injury?

A

The nerve root is torn off the spinal cord at its origin

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2
Q

What is neurapraxia?

A

The nerve is stretched and damaged but not torn

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3
Q

What is a nerve rupture?

A

The nerve is torn at a point along its length

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4
Q

What is axonotmesis?

A

The nerve is partially severed

The axon and myelin sheath are torn but the surrounding epineurium, perineurium, and connective tissue are preserved

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5
Q

What is a post traumatic neuroma?

A

A growth of scar tissue at the site of previous nerve injury that leads to compression of the nerve

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6
Q

What is the injury mechanism that results in Erb’s palsy?

A

A traction injury due to excessive lateral neck flexion to the contralateral side or excessive shoulder depression causing violent stretching (+/- tearing) of the upper portion of the brachial plexus

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7
Q

What could cause Erb’s palsy?

A

Falls onto neck/shoulder

Motorcycling accidents

Direct trauma (clavicle fracture, gun shot wound, stab injury)

Attempts to reduce a shoulder dislocation

Traction injury during difficult/obstructed labour (breech with arms above head, shoulder dystopia + emergency forceps)

Excessive traction on the arm e.g. in sports

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8
Q

Where would a patient with Erb’s palsy experience loss of sensation?

A

The skin over the ‘sergeants patch’, lateral arm, and lateral forearm

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9
Q

In what muscles would you see wasting in a patient with Erb’s palsy?

A

The deltoid, supraspinatus and the anterior compartment of the arm

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10
Q

Which movements are preserved in patients with Erb’s palsy?

A

Wrist flexion and extension, and finger movements

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11
Q

Which movements are lost in a patient with Erb’s palsy?

A

Shoulder abduction
External rotation
Elbow flexion
Wrist supination

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12
Q

Which arm position do patients with Erb’s palsy typically present with?

A

Waiters tip

Limb adducted , internally rotated shoulder, extended elbow and pronated wrist

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13
Q

What reflex is absent in a patient with Erb’s palsy?

A

The bicep reflex is absent

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14
Q

What is the location an Erb’s palsy injury?

A

The superior trunk of the brachial plexus

That affects the suprascapular nerve, the nerve to subclavius, the musculocutaneous nerve and the auxiliary nerve

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15
Q

Is Erb’s palsy an upper brachial plexus injury?

A

Yes Erb’s palsy is an upper brachial plexus injury (injury to the superior trunk)

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16
Q

Is Klumpke’s palsy an upper brachial plexus injury?

A

No Klumpke’s palsy is a lower brachial plexus injury

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17
Q

What is the mechanism of injury that leads to Klumpke’s palsy?

A

A traction injury due to excessive force placed on an abducted shoulder resulting in violent stretching (+/- tearing) of the lower portion of the brachial plexus

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18
Q

What is the site of injury in the brachial plexus that results in Klumpke’s palsy?

A

The inferior frank of the brachial plexus

Affecting the median and ulnar nerves

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19
Q

Which is the rarest brachial plexus syndrome?

A

Klumpke’s palsy

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20
Q

What sensation is lost in a patient with Klumpke’s palsy?

A

Loas of skin sensation in the median and ulnar distributions of the hand and in the medial forearm and arm

21
Q

What sensation is preserved in patients with Klumpke’s palsy?

A

Sensory supply to the lateral dorsum of the hand

22
Q

What muscles would show wastage in patient with Klumpke’s palsy?

A

The muscles of the hand

23
Q

What movements would be lost in a patient with Klumpke’s palsy?

A

Loss of movement in the hand, loss of wrist flexion

24
Q

Which position would a patient with Klumpke’s palsy typically present with?

A

Claw hand

25
Q

What movement is usually preserved in a patient with Klumpke’s palsy?

A

Shoulder movement is usually preserved

26
Q

What injuries could lead to Klumpke’s palsy?

A

A falling person grabbing onto something

Motor biking accident

Direct trauma (GSW, stab injury, clavicle fracture)

Difficult childbirth = arm prevention requiring force on the arm to deliver the baby

Compression of the lower plexus by a ,ass in the root of the neck e,g. Lymphoma or lung cancer

27
Q

What could cause total/complete brachial plexus injury?

A

Severe traction injuries sustained in difficult childbirth

High speed road traffic accidents

28
Q

What is the clinical presentation of someone with a total complete brachial plexus injury?

A

Totally limp, dangling, atrophied, numb upper arm, with associated Horners syndrome

29
Q

What is the most common cause of Klumpke’s palsy?

A

Difficult childbirth

30
Q

What is the site of injury for Horners syndrome?

A

The T1 nerve root

31
Q

What could cause Horner’s syndrome?

A

Cerebral pathology

Traction injury

Direct trauma

Extrinsic compression

32
Q

How does Hornerks syndrome present?

A

Ipsilateral partial ptsosis (drooping eyelid)

Enophthalmos (eye appears sunken)

Anhidrosis (loss of sweating on one side of the face)

Constricted pupil

Loss of sympathetic nerve supply of the face and neck

33
Q

In Horners syndrome caused by nerve root compression what symptoms are present?

A

Hand/arm pain

Wasting of the intrinsic muscles of the hand

34
Q

In Horner’s syndrome caused by traction injuries what other palsy is associated with it?

A

Klumpke’s palsy

35
Q

What is the mechanism of injury that results in Horners syndrome?

A

Any injury to the T1 root that is associated with loss of sympathetic function

36
Q

Where does brachial neuritis/plexitis occur?

A

Any part of the brachial plexus

37
Q

What is the mechanism of brachial neuritis?

A

Inflammatory reaction against the nerves of the brachial plexus

38
Q

What can cause brachial neuritis

A

Brachial neuritis can be triggered by:
Bacterial, viral, parasitic infections

Trauma

Childbirth

Recent surgery

Recent radiotherapy

Systemic inflammation disorders e.g. lupus

Can be idiopathic

Can be part of a polyneuropathy

39
Q

What are the clinical feature of brachial neuritis?

A

Sudden onset of excruciating shoulder and arm pain

Development of paralysis and atrophy of affected muscles

40
Q

How long after onset do patients tend to present for brachial neuritis?

A

Patients present acutely due to the pain

41
Q

In what position do patients with brachial neuritis tend to present?

A

Supporting arm in adducted, internally rotated position

42
Q

What is thoracic outlet syndrome?

A

Compression of the neurovascular structures at the level of the thoracic outlet

43
Q

What part of the brachial plexus does thoracic outlet syndrome affect?

A

The trunks of the brachial plexus

Typically the inferior trunk but can be any and all of the trunks

44
Q

What borders the thoracic outlet?

A

The anterior scalene muscle, middle scalene muscle, clavicle and first rib

45
Q

What can cause thoracic outlet syndrome?

A

Trauma - whiplash

Repetitive strain/sports injuries

Underlying malignancy - lymphoma, lung cancer

Malunion of a clavicular fracture

Cervical rib

Musculoskeletal abnormality

Congenital fibrous tissue band

46
Q

What are the neurological features of thoracic outlet syndrome?

A

Wasting of intrinsic muscles of the hand

Reduced grip strength

Numbness of paraesthesia

47
Q

What are the vascular feature of thoracic outlet syndrome?

A

Subclavian artery compression leads to:

Aching, painful claudication of the arm

Pallor

Extreme cold of the arm

Ischaemia with ulceration and gangrene (in extreme cases)

Subclavian vein compression leads to:

Diffuse arm pain and swelling

Venous distension

Cyanosis

48
Q

Subclavian vein compression as a result of thoracic outlet syndrome leads to:

A

Diffuse arm pain and swelling

Venous distension

Cyanosis

49
Q

Subclavian artery compression as a result of thoracic outlet syndrome leads to:

A

Aching, painful claudication of the arm

Pallor

Extreme cold of the arm

Ischaemia with ulceration and gangrene (in extreme cases)

Upper Limb Anatomy (1 decks)

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