Brachial plexus injury: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray523.png|thumb|Brachial plexus surrounding the brachial artery.]] | |||
[[File:Brachial plexus 2.png|thumb|Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.]] | |||
[[File:Grant 1962 664.png|thumb|Nerve roots that supply sensation to the upper extremities.]] | |||
*Injuries can be penetrating, compression, or closed traction: | *Injuries can be penetrating, compression, or closed traction: | ||
**Supraclavicular (roots and trunks) | **Supraclavicular (roots and trunks) | ||
**Infraclavicular (cords and terminal nerves) | **Infraclavicular (cords and terminal nerves) | ||
{{Causes of brachial plexopathy}} | |||
===Anatomy<ref>Tintinalli. Emergency Medicine. 7th Edition, 2011.</ref>=== | |||
*Roots: | |||
**C5 | |||
**C6 | |||
**C7 | |||
**C8 | |||
**T1 | |||
*Trunks: | |||
**Upper | |||
**Middle | |||
**Lower | |||
*Cords: | |||
**Lateral | |||
**Posterior | |||
**Medial | |||
*Terminal Nerves: | |||
**Musculocutaneous | |||
**Median | |||
**Axillary | |||
**Radial | |||
**Ulnar | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Brachial Plexus Injury during Motorcycle accident.jpg|thumb|Simulated mechanism of injury.]] | |||
*Arm pain (constant, burning) | *Arm pain (constant, burning) | ||
*C5 injury: | *C5 injury: | ||
| Line 35: | Line 42: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Rucksack paralysis]] | |||
{{Shoulder DDX}} | |||
{{Upper extremity peripheral nerve syndromes}} | |||
== | ==Evaluation== | ||
*Clinically evaluate for concurrent phrenic nerve injury and diaphragmatic paresis | |||
*MRI | *MRI | ||
*CT myelography | *CT myelography | ||
| Line 43: | Line 54: | ||
==Management== | ==Management== | ||
*Early neurosurgical consultation | |||
*PT / OT | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[Spinal cord levels]] | |||
*[[Neurologic Exam]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Neurology]] | |||
Latest revision as of 15:00, 5 February 2022
Background
- Injuries can be penetrating, compression, or closed traction:
- Supraclavicular (roots and trunks)
- Infraclavicular (cords and terminal nerves)
Causes of Brachial plexopathy
- Idiopathic
- Post-infectious
- Viral
- Bacterial
- Post-immunization
- Compressive
- Neoplasm
- Post-traumatic
- Penetrating or blunt neck/shoulder trauma
- Traction injury
- Birth trauma
- Connective tissue disorders
- Autoimmune disorders
- Iatrogenic
- Post-surgical
- Medication induced
- Radiation
- Hereditary Neuralgic Amyotrophy
- Rotator Cuff Injury
- Adhesive capsulitis
- Calcific tendinitis
- Thoracic outlet syndrome
- ALS
- Poliomyelitis
- Parsonage-Turner syndrome
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:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Upper extremity peripheral nerve syndromes
Median Nerve Syndromes
Ulnar Nerve Syndromes
Radial Nerve Syndromes
- Radial neuropathy at the spiral groove (ie. "Saturday night palsy")
- Posterior interosseous neuropathy
Proximal Neuropathies
- Suprascapular neuropathy
- Long thoracic neuropathy
- Axillary neuropathy
- Spinal accessory neuropathy
- Musculocutaneous neuropathy
Other
Evaluation
- Clinically evaluate for concurrent phrenic nerve injury and diaphragmatic paresis
- MRI
- CT myelography
- EMG
- Surgical exploration
Management
- Early neurosurgical consultation
- PT / OT
Disposition
See Also
External Links
References
- ↑ Tintinalli. Emergency Medicine. 7th Edition, 2011.