Abos - Hand, Wrist, &forearm:neuropathies/neural Disorders/upper Extremity:brachial Plexopathy

Front 1

The brachial plexus and subclavian artery lie between what two structures in the neck?

Back 1

Anterior scalene muscle
Middle scalene muscle

Front 2

Axillary artery branches are categorized in relation to the pectoralis minor. What branches are in zone 1?

Back 2

Superior thoracic artery

Front 3

What branches are in zone 2?

Back 3

Thoracoacromial artery
Lateral thoracic artery

Front 4

What branches are in zone 3?

Back 4

Subscapular artery (which gives rise to the circumflex scapular artery
Anterior humeral circumflex artery
Posterior humeral circumflex artery

Front 5

What is the clinical feature if the injury is at C5 to C7?

Back 5

Medial winging (long thoracic nerve palsy)

Front 6

What are the two clinical features if the injury is at C8-T1?

Back 6

Horner’s syndrome (inferior ganglion)
Positive histamine response

Front 7

ln general, how do the outcomes of pre- and postganglionic injuries compare?

Back 7

Postganglionic injury outcomes are generally better

Front 8

In general, how do the outcomes of supra- and infraclavicular injuries compare?

Back 8

lnfraclavicular outcomes are generally better

Front 9

What risk factors are associated with obstetric brachial plexus palsy (BPP)?

Back 9

Large baby
Long labor
Shoulder dystocia
Breech
Forceps delivery
Previous birth with shoulder dystocia
or BPP

Front 10

When considering brachial plexus microsurgery, what are the indications for surgery at 1 month?

Back 10

Global palsy

Front 11

What is the significance of the 2-month mark in a child with obstetric BPP?

Back 11

lf deltoid and biceps are firing, complete recovery is possible

Front 12

lf biceps recovery is present by 3 months, what is the next treatment?

Back 12

Continue to observe for recovery

Front 13

What is Horner’s syndrome?

Back 13

Ptosis (drooping eyelid), meiosis (constricted pupil), anhydrosis (lack of sweating); clinical syndrome caused by damage to the
sympathetic nervous system

Front 14

If no biceps recovery is present by 5 to 6 months, what is the next treatment?

Back 14

Brachial plexus microsurgery

Front 15

What is Erb's point?

Back 15

Junction of the C5 and C6 nerve roots

Front 16

An injury at Erb’s point can be identified by sparing of the function of which nerve?

Back 16

Dorsal scapular nerve (already branched off of C5)

Front 17

What roots are affected with Erb-Duchenne palsy?

Back 17

C5-C6

Front 18

What is the position of the arm classically referred to as?

Back 18

Waiter’s tip (shoulder internally rotated, elbow extended, wrist flexed)

Front 19

What palsy has the best prognosis?

Back 19

Erb Duchenne palsy (C5-C6)

Front 20

What roots are affected with Klumpke paralysis?

Back 20

C8-T1

Front 21

What are the resultant clinical features in Klumpke paralysis?

Back 21

No intrinsic function (median or ulnar intrinsics)
No long finger flexors
No flexor pollicis longus or flexor
digitorum profundus

Front 22

What is the prognosis for Klumpke paralysis?

Back 22

Poor

Front 23

In general, what are the goals of treatment while waiting for plexus recovery to take place?

Back 23

Prevent contractures (with passive ROM)
Prevent skeletal changes and joint deformity

Front 24

lf a chronic obstetric BPP is untreated, what is the resulting position of the shoulder?

Back 24

Adduction and internal rotation deformity

Front 25

What are the secondary joint deformities that develop in the shoulder?

Back 25

Glenoid retroversion
Posterior subluxation
Medial flattening of the humeral head

Front 26

What musculoskeletal procedures can be performed if no recovery occurs?

Back 26

Anterior releases
Latissimus dorsi and teres major transfers to the cuff (posterior augmentation)

Front 27

What procedure can be performed for late presentation or fixed shoulder internal rotation deformity?

Back 27

Rotational humeral osteotomy (to gain more external rotation)

Front 28

In general, what are the indications for immediate brachial plexus exploration?

Back 28

Penetrating trauma
Latrogenic injury

Front 29

What are the indications for early exploration (before 3 months)?

Back 29

High-energy injury
Global brachial plexus palsy

Front 30

What are the indications for delayed exploration (3 to 6 months)?

Back 30

Gunshot wound
Low-energy injury
Partial brachial plexus palsy

Front 31

Clinical features suggestive of root avulsion include what pain distribution?

Back 31

Severe pain in anesthetized limb

Front 32

. . .. paralysis of what involuntary musculature?

Back 32

Diaphragmatic paralysis

Front 33

. . .associated injuries that may make one suspicious for possible avulsion include?

Back 33

Transverse process fractures
Scapulothoracic dissocation

Front 34

MRI findings consistent with root avulsion include?

Back 34

Empty root sleeves
Pseudomeningocele (high T2 signal)
Cord shift away from the midline

Front 35

A normal NCV in an anesthetic portion of the upper extremity implies what injury pattern?

Back 35

Avulsion injury (the dorsal root ganglion remains in continuity with the peripheral nerve)

Front 36

What is the general prognosis for avulsion injuries and why?

Back 36

Poor
Because roots are components of central (not peripheral) nervous system
lrreparable damage

Front 37

C8, T1 avulsions are associated with what clinical sign?

Back 37

Horner's syndrome

Front 38

Brachial plexus priorities of repair:in what order should function be restored?

Back 38

Elbow flexion
Shoulder stability
Wrist extension

Front 39

What is a Steindler flexorplasty?

Back 39

Move flexor pronator mass proximally to serve as a flexor of the elbow

Front 40

What is the indication for a flexorplasty?

Back 40

Lack of elbow flexion