Brachial plexus injury

(Redirected from Brachial plexopathy)

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.