Common Syndromes of Brachial Plexus Injuries How can

Common Syndromes of Brachial Plexus Injuries

How can Brachial Plexus become injured? ● Stretch (Neuropraxia) ○ ○ Will heal on its own or require nonsurgical treatment methods like therapy Return to normal function in couple weeks to months ● Tear (Rupture) ○ ○ Partial or fully torn nerve Some are repaired by surgery ● Torn Roots (Avulsion) ○ ○ Nerve roots of brachial plexus have been torn from spinal cord Often are not repaired by surgical interventions (American Academy of Orthopaedic Surgeons, 2018)

Upper Trunk Lesion/Injury

Upper Trunk Lesion/Injury ● More common ● Affects: ○ ventral rami C 5 ○ ventral rami C 6 ○ upper(superior) trunk ○ Or combination of the three listed above (Roberts, 2012)

Upper Trunk Lesion/Injury ● Occurs: ○ ○ ○ (Roberts, 2012) Falling or extreme/violent force at jerks (laterally flexion) head to one side At birth when baby’s head is pulled (laterally flexion) to one side, and their shoulder is depressed Radiation to plexus to fight breast cancer Figure 1 Figure 2 Figure 3

Upper Trunk Lesion/Injury ● Commonly known as either: ○ ○ ○ Erb-Duchenne Paralysis Erb’s Palsy Upper subscapular syndrome ● Results in “Waiter’s Tip” Position ○ ○ Shoulder/Arm Medially Rotated Elbow Extended Forearm Pronated Wristed Flexed Figure 1 (Roberts, 2012)

Upper Trunk Lesion/Injury ● Depending on the site of injury the following muscles may be affected: ○ ○ ○ ○ Rhomboids Levator scapulae Infraspinatus Supraspinatus Brachioradialis Biceps brachii Brachialis Deltoid ● Depending on the site of injury an individual may experience sensory loss of lateral aspect of upper arm ○ Due to stress or lesion prior to sensory nerve segment that branches from Axillary nerve known as lateral brachial cutaneous nerve (C 5, C 6) (Roberts, 2012)

Middle Trunk Lesion/Injury

Middle Trunk Lesion/Injury ● Very Rare ● Affects: ○ ○ ○ (Roberts, 2012) Isolation of ventral rami C 7 Middle trunk lesion Or combination of the Two

Middle Trunk Lesion/Injury ● Occurs: ○ “ Trauma to shoulder in an anterior-posterior direction” (Roberts, 2012, p. 13 ) ● Result in: ○ ○ Muscle weakness in arm and forearm extensors Sensory loss of radial nerve distribution ■ ■ ○ (Roberts, 2012) Posterior arm and forearm Dorsal aspect of hand 1 -4 ½ digits. Note that some sensory loss may occur in distribution of Median and Musculocutaneous Nerve

Lower Trunk Lesion/Injury

Lower Trunk Lesion/Injury ● Affects: ○ ○ (Roberts, 2012) ventral rami C 8 ventral rami T 1 Lower (inferior) trunk Or combination of the three listed above

Lower Trunk Lesion/Injury ● Occurs: ○ ○ With forceful pulling of arm upward At birth when a baby’s hand/arm is forceful pulled (Roberts, 2012) Figure 4

Lower Trunk Lesion/Injury ● Commonly referred as: ○ ○ Klumpke Palsy Dejerine Palsy ● Results in: ○ ○ ○ Lost in digit flexion and extension Lost in intrinsic hand function Total Claw Hand Figure 5 (Roberts, 2012)

Lower Trunk Lesion/Injury ● Depending on the site of injury the following muscles innervated by Ulnar Nerve: ○ ○ Flexor carpi ulnaris Flexor digitorum profundus (4 th-5 th ● Sensation loss ○ Medial aspect of arm/forearm ■ ■ Medial brachial cutaneous Medial antebrachial cutaneous digit) ○ ○ ○ ○ Palmaris brevis Abductor digiti minimi Opponens digiti minimi Flexor digiti minimi Lumbricals (4 th-5 th digit) Interossei Flexor pollicis brevis Adductor pollicis (Roberts, 2012)

References American Academy of Orthopaedic Surgeons. (2018). Disease and conditions: Brachial plexus injuries. In Ortho. Info. Retrieved from https: //orthoinfo. aaos. org/en/diseases--conditions/brachial-plexus-injuries Roberts, S. E. (2012). Peripheral nerves in the upper extremity. Everyday upper extremity anatomy a clinical guide, reference, and interactive workbook. (pp. 1321) Skokie, IL: Denoyer-Geppert Science Company.

Image References Figure 1: Mobile Physiotherapy Clinic Ahmedabad Gujarat. (2018). Erb’s palsy injury [digital image]. http: //mobilephysiotherapyclinic. in/erbs-palsy-and-treatment/ Figure 2: Bower, M. R. (2010). What is erb's palsy[digital image]. http: //www. erbspalsyonline. com/ Figure 3: Breastcancer. org. (2012). Image - Radiation Treatment - Front view [digital image]. https: //www. breastcancer. org/pictures/treatment/radiation Figure 4: Lindsey Pollak, LLC. (n. d. ) [digital image]. https: //www. lindseypollak. com/favorite-motivational-quotes/ Figure 5: Lineage Medical, Inc. (2018). Intrinsic minus hand (claw hand) [digital image]. https: //www. orthobullets. com/hand/6010/intrinsic-minus-hand-claw-hand