lesions of brachial plexus

Question 1

Answer 1

1. musculocutaneous(C5,6,7)
   
   1. innervation
      
      1. anterior ram
      2. becomes lateral cutaneous nerve of forearm
2. median(C6-T1)
   
   1. innervate
      
      1. anterior compartment of forearm
         
         1. except
            
            1. flexor carpi ulnaris
            2. part of flexor digitorum profundus(lunar)
3. ulnar(C8-T1)
   
   1. innervate
      
      1. some forearm muscles and medial hand
4. radial(C5-T1)
   
   1. innervate
      
      1. posterior aspect of upper extermity
5. axillary(C5-C6)
   
   1. innervate
      
      1. deltoid
      2. teres minor
      3. long head of tricep

Question 2

during a football game and a tackle forces the head and neck toward the shoulder.

what is the

Answer 2

1. this is called a burner aka stinger
   
   1. symptoms
      
      1. accompnanied by numbness and weakness
      2. short-lived or weeks, if severe
   2. cause
      
      1. head an neck are forced toward the shoulder, compressing the nerves that lead from the spinal cord to that arm, or the head and neck are forced away from the shoulder, strertching those nerves

Question 3

describe the types of lesions to the brachial plexus

1. avulsions
2. rupture
3. neuroma
4. neuropraxia

Answer 3

1. brachial plexus lesions
   
   1. injury to brachial plexus affets movements and cutaneous sensation of upper limb
      
      1. avulsions
         
         1. nerve is torn from the spine
      2. rupture
         
         1. nerve is torn but not at the spinal attachment
      3. neuroma
         
         1. nerve has torn and healed but scar tissue puts pressure on the injured nerve and prevents it from conducting signals to the muscles
      4. neuropraxia-stretch
         
         1. the nerve has been damaged but not torn
            
            1. most common type of brachial plexus injury

Question 4

what can cause damage to the C5-C6 nerves? what is the outcome?

Answer 4

Erb-Duchenne Plasy

1. cause
   
   1. paralysis of the UPPER brachial plexus
   2. stretching at neck and shoulder
      
      1. chronic micro trauma from heavy backpack can cause deficits
   3. birth
   4. falling on neck
2. symptoms
   
   1. adducted shoulder
   2. extended elbow
   3. medial rotation
   4. “waiters tip” position

Question 5

what are the causes of damage to the C8/T1 nerves? what are the outcomes and presentations?

Answer 5

Klumpke Paralysis

1. cause
   
   1. lower portion of brachial plexus (C8 and T1) damaged
   2. occurs when upper limb is pulled superiorly
2. paralysis of the lower brachial plexus
   
   1. intrinsic muscles of the hand are affected
      
      1. “Claw Hand”

Question 6

what is this patients presentation?

Answer 6

Ape Hand

1. presentation
   
   1. deformity do to inability to abduct or oppose the thumb
      
      1. leaving the thumb resting ina adduction, rotated parallel to the plane of the palm
2. cause
   
   1. deformity due to severe median neuropathy

Question 7

what is the muslce, nerve, function loss with lesion

Answer 7

rhomboid major/minor

1. dorsal scapuular nerve
2. function loss
   
   1. scapular retraction

Question 8

what is the muslce, nerve, function loss with lesion

Answer 8

serratus anterior

1. long thoracic
2. function loss
   
   1. scapular protraction and upward rotation

Question 9

what is the muslce, nerve, function loss with lesion

Answer 9

supraspinatus and infraspinatus

1. suprascapular
2. function loss
   
   1. initial 15 degrees abduction
   2. external rotation
   3. shoulder stabilization

Question 10

what is the muslce, nerve, function loss with lesion

Answer 10

latissimus dorsi

1. thoracodorsal
2. function loss
   
   1. adduct shouulder
   2. medial rotation

Question 11

what is the muslce, nerves, function loss with lesion

Answer 11

subscapularis and teres major

1. inferior subscapular
2. function loss
   
   1. internal rotation
   2. adduction
3. superior buscapular nerve
   
   1. subscapularis
   2. LOF
      
      1. internal sholder rotation

Question 12

what is the muslce, nerve, function loss with lesion

Answer 12

deltoid and teres minor

1. axillary
2. fnction loss
   
   1. abduction
   2. flexion
   3. extension
   4. external rotation

Question 13

what is the muslce, nerve, function loss with lesion

Answer 13

all muscles in the posteriorcompartments of arm and forarm

1. radial nerve
2. function loss
   
   1. extension of elbow, wrist and digits

Question 14

what is the muslce, nerve, function loss with lesion

Answer 14

pectoralis major &/or pectoralis minor

1. lateral and medial pectoral
2. lateral nerve lesion function loss
   
   1. adduction
   2. medial rotation
   3. scapular protraction
   4. hmeral flexion
3. medial nerve lesion
   
   1. pec major-see above
   2. pec minor
      
      1. attachement to scapula

Question 15

what is the muslce, nerve, function loss with lesion

Answer 15

biceps brachii

1. muscuulocutaneous
2. function loss
   
   1. elbow flexion
   2. adduct shoulder
   3. stabilize shoulder

Question 16

what is the nerve, function, loss of function with lesion

Answer 16

median nerve

1. function
   
   1. motor
      
      1. all muscles in the anterior compartment of the forarm( except flexor carpi lnaris and medial half of flexor digitorum profundus), three thenar muscles of the thumb and two lateral lumbrical muscles
   2. sensory
      
      1. skin over the palmar surface of the lateral three and 1/2 digits and over the lateral side of the palm and middle of the wrist
2. LOF
   
   1. flexion of the wrist and digits
   2. movement of the thumb

Question 17

what is the nerve, function, loss of function with lesion

Answer 17

ulnar

1. function
   
   1. motor
      
      1. all intrinsic muslces of the hand (except three thenarmuscles and two lateral lumbricals); also flexor carpi ulnaris and the medial half of flexor digitorum profundus in the forearm
   2. sensory
      
      1. skin over the palmar surface of the medial one and 1/2 digits and associated palm and wrist over the dorsal srface of the media l1 and 1/2 half digits
2. LOF
   
   1. ?

Question 18

list the brachial plexus injuries in accordance to injury at the different sections of the brachial plexus.

Answer 18

Question 19

jerry suffered fromscalene muscle swelling, what may result from his condition? what is the name of the outlet affected?

Answer 19

thoracic outlet syndrome-conents in the thoracic outlet are affected

1. cause
   
   1. pressure on nerves and vessels in thoracic outlet by
      
      1. fractured clavicle
      2. cervical rib
      3. scalen tissue build up
      4. neck and arm position
2. presentation
   
   1. pain, numbness, arm/shouulder feels cold and heavy

Question 20

Jerry was born with cervical ribs, what are these and what can develope from this anaomly?

Answer 20

cervical rib=an extra rib which arises from the seventh cervical vertebra

1. occurs on C7
2. may have an elarged costal process (cervical rib) that stretches or compresses the subclavian artery and/or lower part of brachial plexus.
   
   1. a form of thoracic outlet syndrome?