Brachial plexus injury

Background

  • Injuries can be penetrating, compression, or closed traction:
    • Supraclavicular (roots and trunks)
    • Infraclavicular (cords and terminal nerves)

Anatomy[1]

  • Roots:
    • C5
    • C6
    • C7
    • C8
    • T1
  • Trunks:
    • Upper
    • Middle
    • Lower
  • Cords:
    • Lateral
    • Posterior
    • Medial
  • Terminal Nerves:
    • Musculocutaneous
    • Median
    • Axillary
    • Radial
    • Ulnar

Clinical Features

  • Arm pain (constant, burning)
  • C5 injury:
    • weakness of deltoid and infraspinatus causes adducted, internally rotated shoulder
  • C6 injury:
    • weakness of biceps causes elbow extension
  • C7 injury:
    • weakness of extensor muscles causes wrist and digit flexion

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

  • Clinically evaluate for concurrent phrenic nerve injury and diaphragmatic paresis
  • MRI
  • CT myelography
  • EMG
  • Surgical exploration

Management

  • Early neurosurgical consultation
  • PT / OT

See Also

References

  1. Tintinalli. Emergency Medicine. 7th Edition, 2011.
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