UPPER LIMB: BRACHIAL PLEXUS LESION

UPPER (C5 AND C6) BRACHIAL PLEXUS LESION: ERB-DUCHENNE PALSY (WAITER’S TIP SYNDROME) Usually occurs when the head and shoulder are forcibly separated (e.g., accident or birth injury or herniation of disk) Trauma will damage C5 and C6 spinal nerves (roots) of the upper trunk. Primarily affects the axillary, suprascapular, and musculocutaneous nerves with the loss […]

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UPPER (C5 AND C6) BRACHIAL PLEXUS LESION: ERB-DUCHENNE PALSY (WAITER’S TIP SYNDROME)

  • Usually occurs when the head and shoulder are forcibly separated (e.g., accident or birth injury or herniation of disk)
  • Trauma will damage C5 and C6 spinal nerves (roots) of the upper trunk.
  • Primarily affects the axillary, suprascapular, and musculocutaneous nerves with the loss of intrinsic muscles of the shoulder and muscles of the anterior arm.
  • Arm is medially rotated and adducted at the shoulder: Loss of axillary and suprascapular nerves.
  • The unopposed latissimus dorsi and pectoralis major muscles pull the limb into adduction and medial rotation at the shoulder.
  • The forearm is extended and pronated: loss of musculocutaneous nerve.
  • Sign is “waiter‟s tip.”
  • Sensory loss on lateral forearm to base of thumb: loss of musculocutaneous nerve.

LOWER (C8 AND T1) BRACHIAL PLEXUS LESION: KLUMPKE’S PARALYSIS

  • Usually occurs when the upper limb is forcefully abducted above the head (e.g., grabbing an object when falling, thoracic outlet syndrome or birth injury)
  • Trauma will injure the C8 and T1 spinal nerve roots of inferior trunk.
  • Primarily affects the ulnar nerve and the intrinsic muscles of the hand with a weakness of the median innervated muscles of the hand.
  • Sign is combination of “claw hand” and “ape hand” (median nerve).
  • May include a Horner syndrome.
  • Sensory loss on medial forearm and medial 1½ digits.

 

RADIAL NERVE

  • Axilla: (Saturday night palsy or using crutches)
    • Loss of extension at the elbow, wrist and MP joints
    • Weakened supination
    • Sensory loss on posterior arm, forearm, and dorsum of thumb
    • Distal sign is “wrist drop.”
  • Mid-shaft of humerus at radial groove or lateral elbow (lateral epicondyle or radial head dislocation)
    • Loss of forearm extensors of the wrist and MP joints
    • Weakened supination
    • Sensory loss on the posterior forearm and dorsum of thumb
    • Distal sign is “wrist drop.”
    • Lesions of radial nerve distal to axilla, elbow extension are spared.

Bones of Upper Limb

1
CLINICAL ASPECT OF UPPER LIMB: BONES AND JOINTS
30 Min

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