Title Brachial plexus & peripheral nerve injury ✅

Brachial Plexus & Peripheral Nerve Injury Brachial Plexus Injury Anatomy ● Formed by the confluence of nerve roots from C5 to T1 ● It is innervated the structures of upper limb Neck Roots (5):Ventral rami of C5, C6, C7, C8, and T1 Trunks (3):Superior, Middle, inferior Behind the clavicle Divisons (6): 3 Anterior, 3 Posterior Iman, Izzaty, Nisa, Lissa (2/3/21) Forti

Total plexus injury ● Injury to C5 to T1 ● Paralysis and numbness over entire upper limb Upper plexus injury ● Injury to C5 and C6 ● Paralysis of shoulder abductor, external rotators and forearm supinators ● Loss of sensation over the outer aspect of arm and forearm Lower plexus injury ● Paralysis of intrinsic hand muscle ● Lost of sensation along ulnar aspect of forearm Obstetrical brachial plexus palsy 1. Upper root injury: Erb’s palsy difficult delivery in infants or fall onto shoulder in adults ● Injuries of C5 and C6 ● Excessive displacement of head to opposite side and depression of shoulder on same side producing traction on plexus ● The abductor, external rotators of shoulder and supinators are paralyzed Physical examination ● Arm is held to side ● Waiter’s tip : adducted, internally rotated at shoulder and pronated and extended at elbow ● Sensory loss of lateral of arm and forearm Iman, Izzaty, Nisa, Lissa (2/3/21) Forti
2. Lower root injury: Klumpke’s palsy ● Due to injury of C8 and T1 which usually avulsion injuries caused by excessive abduction. ● Frequently a/w a preganglion injury and Horner’s syndrome. ● Poor prognosis. Physical examination: ● Deficits of all of the small muscles of the hand (ulnar and median nerve). ● Arm supinated and elbow flexed. Clinically, present as “claw hand”. ● Wrist held in extreme extension because of the unopposed wrist extensors. ● Hyperextension of MCP and flexion of IP joints d/t loss of hand intrinsics Iman, Izzaty, Nisa, Lissa (2/3/21) Forti