Upper limb (Brachial plexus and Injury)

Question 1

What occurs with an Median Nerve injury?

Answer 1

1. Injury

• At elbow joint (supracondylar fracture)
• Loss of Pronation of forearm

2. Hand of Benediction
   * Loss of Opposition of the thumb
3. Ape Hand

• Atrophy of thenar muscles
• Flattening of Thenar eminence

Question 2

What occurs with an Ulnar Nerve Injury?

Answer 2

1. Supply

• Palmaris brevis
• Lumbricals 3-4
• Interossei
• Adductor pollicis (Thenar muscle but except: outside of thenar compartment)

2. Injury

• Ulnar groove
  
  • Cutbital tunnel syndrome
• Guyon’s canal
  
  • Ulnar tunnel syndrome

3. Claw hand

• Loss of adduction of thumb
• Loss of Extension at interphalangeal joints
• Loss of Abduction and Adduction (2-5 digits)

Question 3

What occurs with Injury to Superior Trunk of Brachial Plexus?

Answer 3

1. Traction injury

• Falling on head and extension from neck and shoulder
• Baby being pulled out

2. C5 and C6 nerve root injury
3. Suprascapular nerve

• Affecting Supraspinatus and Infraspinatus
  
  • Affects Abduction of arm and Lateral rotation of arm

4. Clinical

• Erb-Duchenne paralysis
• “Waiter’s tip” position
  
  • Limb hangs by side
  • Shoulder adducted
  • Arm medially rotated
  • Elbow extended
  • Forearm pronated

Question 4

What occurs to Lateral cord injuries of the Brachial Plexus?

Answer 4

1. Musculocutaneous nerve damaged

• Affects
  
  • Brachialis (flexion of forearm)
  • Biceps brachii (Supination of forearm)
  • Coracobrachialis (Flexion of arm)

Question 5

What occurs to Posterior Cord injuries in the Brachial Plexus?

Answer 5

1. Upper subscapular
   * Subscapularies
2. Axillary

• Teres minor (lateral rotation of arm)
• Deltoid (abduction of arm)

3. Radial
   * Brachioradialis (flexion of forearm)

Question 6

What occurs with Inferior truck injury?

Answer 6

1. Usually a traction injury

• Hanging from tree (arm extended)
• Pulling baby out by arm

2. Clinical

• Klumpke’s paralysis
  
  • A birth palsy that results in claw hand