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
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