Nerve Lesions For Upper Limb, \

Front 1

NERVE LEVEL OF LESION
C5-c6
Neck (posterior triangle)

Back 1

Forearm pronated, palm facing backward
(“Waiter’s tip hand”, Erb-Duchenne paralysis)

Front 2

T1 Neck (posterior triangle)
[pulmonary carcinoma or “cervical” rib may also involve T1]

Back 2

Loss of intrinsic mm. of hand
“Clawed” hand because of unopposed long flexors and extensors (Klemke’s paralysis)

Front 3

Long Thoracic (C5,6,7) Superior axilla

Back 3

Winged scapula (serratus anterior)

Front 4

Suprascapular (C5,6) Neck (posterior triangle)

Back 4

Difficulty initiating ABduction of arm (supraspinatus, infraspinatus)

Front 5

Musculocutaneous (C5,6,7) Axilla

Back 5

Severely weak forearm flexion and supination (biceps, brachialis)
Loss of sensation in lateral forearm

Front 6

Axillary
(C5,6) Surgical neck of humerus and quadangular space

Back 6

Difficulty elevating limb above horizontal (deltoid)

Front 7

Radial
(C5-T1) Axilla

Back 7

Crutch paralysis (“Sat. night palsy”)
Wrist drop (loss of forearm extension)
Sensory loss on posterior hand
Loss of extension of proximal phalanges
Loss of ABduction and Adduction of fingers and thumb (extensor mm.)

Front 8

Radial Radial groove of humerus

Back 8

Same as above, but little loss of forearm extension

Front 9

Radial Neck of radius (deep radial)

Back 9

NO WRIST DROP!!
Loss of extension of phalanges and thumb movements
NO SENSORY LOSS

Front 10

Median
(C5-T1) Axilla, arm, elbow

Back 10

Loss of forearm pronation
Weak wrist and finger extension
Weak thumb flexion and ABduction
NO thumb opposition (compensated for by ADductor pollicus longus)
Flat thenar eminence (paralysis of thenar m.)
Paralysis of 1st two lumbricals (poor fine motor control of 2nd and 3rd digits)
Severe loss of sensation in lateral palmar surface of hand (including tips of fingers)
Loss of sweating in lateral palm (SNS)

Front 11

Median Wrist

Back 11

Same as above, but NO loss of pronation or hand flexion

Front 12

Ulnar
(C7-T1) Axilla, arm or medial epicondyle

Back 12

Motor and sensory loss to hand
Hand drawn radially upon wrist flexion (due to flexor carpi radialis)
Paralysis of most intrinsic hand mm. (difficulty making a fist)
NO flexion of ring finger or little finger at DIP joint (“claw-hand” appearance)

Front 13

Ulnar Wrist

Back 13

Same as above, but clawing is more severe because flexor digitorum profundus is intact and there is NO loss of Adduction of hand.

Front 14

Median and Ulnar Proximal to elbow

Back 14

Same as above (4) cases, but clawing is minimal because all long flexors are lost; clawing increases during recovery