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:Dermatomes and cutaneous nerves - anterior.png|thumb|Dermatomes and cutaneous nerves - anterior]]
[[File:Dermatomes and cutaneous nerves - anterior.png|thumb|Dermatomes and cutaneous nerves - anterior]]
[[File:Dermatomes and cutaneous nerves - posterior.png|thumb|Dermatomes and cutaneous nerves - posterior]]
[[File:Dermatomes and cutaneous nerves - posterior.png|thumb|Dermatomes and cutaneous nerves - posterior]]
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==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:  
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==Differential Diagnosis==
==Differential Diagnosis==
*[[Rucksack paralysis]]
*[[Rucksack paralysis]]
{{Shoulder DDX}}


==Evaluation==
==Evaluation==

Revision as of 20:47, 21 May 2020

Background

Brachial plexus surrounding the brachial artery.
Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.
Dermatomes and cutaneous nerves - anterior
Dermatomes and cutaneous nerves - posterior
  • 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

Simulated mechanism of injury.
  • 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

Disposition

See Also

External Links

References

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