Brachial Plexus Injuries

Front 1

Common causes of Brachial Plexus injuries

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compression, traction, stab wounds

Front 2

Upper lesions usually include

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C5-C6

Front 3

Lower lesions usually include

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C8-T1

Front 4

Injuries that happen above the clavicle/supraclavicular usually involves

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roots and trunks

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Injuries that happen along the infraclavicular usually involves

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divisions, cords, and terminal branches

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The erb-duchenne's palsy can happen (MOI) ________________ or ___________________

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in infants during a difficulat delivery

in adults following a fall or a blow to the shoulder

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What nerves are involved in the erb-duchenne's palsy?

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Suprascapular, nerve to subclavius, musculocutaneous, and axillary nerve

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What muscles are affected in erb-duchenne's palsy?

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Abductors (supraspinatus and deltoids) and Lateral Rotators (infraspinatus and teres minor)

Subclavius (due to nerve to subclavius)

biceps, brachialis, and coracobrachialis (due to musculocutaneous nerve)

Front 9

This deformity manifests due to the loss of shoulder/arm abduction and external rotation

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Porter's Tip or Waiter's tip deformity

Front 10

This is usually caused by excessive abduction of the arm

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Klumpke's palsy

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What roots are involved in the erb-duchenne palsy?

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C5-C6

Front 12

What roots are involved in the Klumpke's palsy?

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C8-T1

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The klumpke's palsy can manifest as _______________ and ________________

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Claw hand deformity and Horner's syndrome

Front 14

The horner's syndrome can manifest in 4 ways

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Ptosis, Miosis, Anhidrosis, Enophthalmos

Front 15

This is otherwise known as sunken eyeballs

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Enophthalmos

Front 16

This is otherwise known as the loss of facial sweating

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Anhidrosis

Front 17

This is otherwise known as drooping eyelids

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Ptosis

Front 18

This is otherwise known as pupillary constriction

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Miosis

Front 19

What roots are affected in the erb-klumpke's paralysis?

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C5-T1

Front 20

Three manifestations of erb-klumpke's paralysis

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Waiter's tip, claw-like hand deformity, horner's syndrome

Front 21

What nerves are damaged when there is erb-klumpke's paralysis

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sympathetic nerves

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Caused by traction on the shoulder, but not an obsteric palsy

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Burner's Pain

Front 23

Another name for Burner's Pain

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Stinger's Pain

Front 24

Another name for stinger's pain

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Burner's pain

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What roots are affected by the Burner's/Stinger's pain

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C5-T1

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MOI of burner's/stinger's pain

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Traction to the nerve root or traction of the shoulder

Front 27

What is the clinical manifestation of burner's/stinger's pain?

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tingling paresthesia on the whole upper extremity

Front 28

How does the dorsal scapular nerve get damaged? (MOI)

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Direct trauma on the portion of the shoulder region & neck area caused by a knife wound/gunshot wound

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How does the DSN injury manifest?

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Mild winging or inferior/posterior tipping of the scapula

Forward head posture

Front 30

How does the Long Thoracic Nerve get damaged?

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Knife wound on the medial wall of the axilla (Axillary nerve might also be damaged)

Front 31

How does an injury to the Long Thoracic Nerve manifest?

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Medial winging, open book deformity

Front 32

If there is an lesion due to the Long Thoracic Nerve, what are the possible causes?

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Scalenus medius entrapment

Compression & traction

Carrying heavy objects

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How does the Long Thoracic Nerve Lesion manifest?

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Medial winging

Inability to raise the arm above horizontal

Front 34

This nerve injury causes a person to lack stability of the Sternoclavicular Joint

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Nerve to subclavius injury

Front 35

In the event that the nerve to subclavius is damaged, how does the clavicle move?

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It moves posteriorly and superiorly

Front 36

When the suprascapular nerve gets damaged, what are the muscles that get affected?

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Paralyzed supraspinatus (abduction) and Infraspinatus (External Rotation)

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This syndrome happens when there is a compression of vessels and nerves in the area of the clavicle

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Thoracic Outlet Syndrome

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Where are the sites of the suprascapular notch entrapment

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suprascapular and spinoglenoid notch

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What can cause a suprascapular nerve entrapment?

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Ganglion cyst

Ossification of the superior transverse scapular ligament

Repetitive trauma

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What is the MOI of Cubital Tunnel Syndrome?

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Direct trauma

Severe cubitus valgus

Compression

Fracture to medial epicondyle

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Another name for Cubital tunnel syndrome

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Tardy Ulnar Palsy

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What are the boundaries of Canal of Guyon

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Pisiform, hook of hamate, & pisohamate ligament

Front 43

What is the MOI of the Biker's syndrome?

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Impingement of ulnar nerve at the canal of guyon

Front 44

What muscles are weak when there is Biker's Syndrome

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Adductor Pollicis and Hypothenar Muscles

Front 45

The sensory lost in biker's syndrome

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Ulnar aspect of the hand (4th to 5th digits)

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In a passive papal benedictine sign, what digits can move? what cannot?

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1st, 2nd, 3rd can move

4th and 5th cannot

Front 47

True or false: You cannot open the digits when you close your hand in a passive papal benedictine sign

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True

Front 48

Thickening of palmar fascia

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Depuytren's contracture

Front 49

Sites of the compression of the radial nerve

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Axilla

Spiral groove

Injury to the deep branch (supinator tunnel)

Injury to the superficial branch

Front 50

This is the largest nerve in the UE; superficially located

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Radial nerve

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Highest level of injury

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Axilla (Radial nerve)

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A radial nerve injury in the axilla can show problems in the motor functions such as

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Elbow extension and wrist drop

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Highest point of compression

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Cubital tunnel (axilla)

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Lowest point of compression

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Carpal tunnel

Front 55

A radial nerve injury in the axilla can show problems in the sensory functions such as

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Loss over the dorsal aspect of the lateral 3 1/2 fingers

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True or False: A problem in the ulnar nerve can also cause crutch palsy (chronic)

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False, it is caused by a damaged radial nerve in the Axilla

Front 57

A radial nerve injury in the spiral groove can show problems in the motor functions such as

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Wrist drop only

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A radial nerve injury in the spiral groove can show problems in the sensory function such as

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Loss over the dorsal aspect of the lateral 3 1/2 fingers

Front 59

What muscles are affected when the deep branch of the radial nerve is injured?

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APL, EPB, EPL, EIP (Tunnel 1, 3, 4)

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When the Deep branch of the radial nerve is injured, what motor function is weakened?

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MCP extension weakness

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True or false: there is no wrist drop when the deep branch of the radial nerve is injured

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True

Front 62

What sensory functions are affected when the deep branch of the radial nerve is injured

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none

Front 63

This is known as a pure motor injury

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deep branch of radial nerve injury (PIN) elbow

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The superficial branch of the radial nerve injury is also known as

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handcuff injury

Front 65

This is also known as a pure sensory injury

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Superficial branch of the radial nerve injury (wrist)

Front 66

What motor functions are affected when the superficial branch of the radial nerve is injured?

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None

Front 67

What sensory functions are affected when the superficial branch of the radial nerve is injured

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Loss of sensation on the dorsal surface of the roots of the lateral three fingers

Front 68

When the musculocutaneous nerve is injured, what motor muscles are affected?

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Coracobrachialis

Biceps brachii

Brachialis

Front 69

When the musculocutaneous nerve is injured what sensory function is affected?

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Lateral aspect of the forearm

Front 70

The musculocutaneous nerve emerges _______ to the _________

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laterally to the biceps tendon

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The musculocutaneous nerve provides sensory innervation to the ____________ of the forearm

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antero-lateral aspect

Front 72

Is the musculocutaneous nerve injury pure motor or pure sensory?

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Pure sensory as it crosses the elbow joint

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This nerve is rarely damaged

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Musculocutaenous nerve

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What causes the musculocutaneous nerve to get injured?

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Anterior shoulder dislocation; clavicular fractures; repetitive trauma

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How does an injury to the musculocutaneous nerve manifest?

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Causes weakness in elbow flexion and supination

Sensory disturbance on lateral aspect of the firearm

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Where are the sites of median nerve

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At the elbow

Wrist above the flexor retinaculum

In the carpal tunnel

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Highest level of entrapment of supracondylar process syndrome

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Ligament of struthers

Front 78

What motor functions are affected in the Supracondylar process syndrome?

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Paralysis of the proator teres, finger flexors, and lateral half of FDP FPL

Front 79

Two manifestations of the supracondylar process syndrome

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Wasting of thenar eminence (ape hand deformity) & active papal benedictine sign

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What is highest level of entrapment near the medial epicondyle

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Ligament of struthers

Front 81

In an active papal benedictine sign, what fingers can move? what cannot?

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4th and 5th fingers can move

1st, 2nd, 3rd cannot

Front 82

This is known as a dynamic contracture

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Active papal benedictine sign

Front 83

Guttering at palmar aspect is a problem with what nerve

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Median nerve

Front 84

Guttering at the dorsal aspect is a problem with what nerve

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Ulnar nerve

Front 85

What sensory function is affected with the supracondylar process syndrome?

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Loss of sensation over lateral 3 1/2 digits

Front 86

An injury to the median nerve is between _______

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pronator teres/ compression b/w 2 heads of pronator teres

Front 87

When there is an injury to the median nerve, what muscle is spared?

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Pronator teres

Front 88

What is wasted in an injury to median nerve?

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Wasting of flexor and thenar eminence (deformity)

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An injury to the median nerve is purely motor, which affects the muscles

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Pronator Quadratus

2 Lateral FDPs

FPL

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An injury to the median nerve can manifest as

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guttering

active papal benedictine sign

claw hand deformity

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The entrapment of the forearm is known as

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Anterior Interosseous Nerve syndrome

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When there is an entrapment of the forearm, there is a compression under ________

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the ganzter muscle (accessory head of the FPL)

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When there an entrapment at the wrist, it is known as

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Carpal tunnel syndrome

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When there is entrapment at the wrist, there is compression _________

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beneath rthe flexor retinaculum

Front 95

What demographic is mostly common with the entrapment at the wrist?

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Female, 40-60, dominant hand

Front 96

This is MC associated with pregnancy

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Entrapment at the wrist/carpal tunnel syndrome

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In carpal tunnel syndrome, there is _______ and ___________

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weakness and atrophy of thenar muscles

Front 98

Another term for an injury of nerve to subclavius

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Thoracic Outlet Syndrome