Upper Limb Nerve Injuries Anatomy Department Pak International

Upper Limb Nerve Injuries Anatomy Department Pak International Medical College

Layout �Brachial Plexus �Long Thoracic Nerve �Axillary Nerve �Musculocutaneous Nerve �Radial Nerve �Ulnar Nerve �Median Nerve

Basic Principal of Nerve Injuries �If nerve to flexors is damaged- joints will become extended due to unopposed action of extensors and vice versa �Same is true for abductors and adductors, medial & lateral rotators, supinators & pronators �There will be sensory loss of the area of skin supplied by the nerve

Brachial Plexus �Pre- & Post-fixed Brachial Plexus �Upper Lesions �Lower Lesions Parts of Brachial Plexus are? ? ?

Brachial Plexus

Pre- & Post Fixed Brachial Plexus Prefixed Brachial Plexus —Occurs when the C 4 ventral ramus contributes to the brachial plexus. Contributions to the plexus usually come from C 4 - C 8 Postfixed Brachial Plexus—Occurs when the T 2 ventral ramus contributes to the brachial plexus. Contributions to the plexus usually come from C 6 - T 2.

Upper Lesions: Erb-Duchenne Palsy �Causes: Difficult delivery / blow to or fall on shoulder �What Happens: excessive traction or tearing of C 5 -C 6 roots �Damage: Suprascapular, Subclavius, M-C, Axillary nerves �Result: Waitor’s Tip �Clinical Picture: 1. Limb hangs limply 2. Medially Rotated 3. Forearm Pronated 4. Loss of sensation on lateral forearm

Erb-Duchenne Palsy

Lower Lesions: Klumpke Palsy �Causes: Cervical Rib/ Excessive abduction of arm e. g falling from height and clutching to save oneself �What happens: T 1 nerve is torn �Damage: Part of Ulnar & Median nerve to small muscles of hand �Result: Clawed appearance � Clinical Picture: 1. Hyperextension of MCP and Flexion of IP joints 2. Loss of sensation along medial side of arm Which other nerve damage produces claw hand? ? ?

Klumpke’s Palsy Claw Hand

Long Thoracic Nerve �Cause: Blows to or pressure on the posterior neck / during radical mastectomy �What Happens: innervation to serratus anterior is lost �Result: Winged Scapula �Clinical Picture: difficulty in raising the arm above the head as scapula cannot be rotated

Axillary Nerve �Causes: Downward displacement of humeral head in shoulder dislocation/ Fracture surgical neck/ pressure from clutch �What Happens: Nerve Supply to deltoid & teres minor is lost & cutaneous loss �Result: sensory loss over LOWER HALF of deltoid & ? ?

Musculocutaneous Nerve �Rarely injured because lies under cover of ? ? ? �If injured high up- Loss to BBC muscles ? ? ? �Result: flexion at elbow is then done by brachialis, brachioradialis & pronator teres �Sensory loss along lateral forearm

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