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Flashcards in Brachial Plexus Deck (14):
1

List the principles of nerve transfer

- Donor: should be expendable

- Donor: should be close to end-organ target

- Donor: should be synergistic/easy to relearn

- Tension free coaptation – donor distal, recipient proximal

- Motor nerve transfer should be end to end

sensory nerve transfer : end-to-end if critical sensation, end to side if non-critical sensation

2

What features differentiate a preganglionic from postganglionic BP injury

Preganglionic = root avulsion (proximal to DRG)

Postganglionic = nerve rupture/neuroma in continuity

Evaluation Technique

Supraganglionic Lesion

Infraganglionic Lesion

 

Inspection

Flail arm, winged scapula, Horner’s syndrome

Flail arm

Manual muscle testing

Paralysis of serratus anterior, rhomboids +/- diaphragm and limb musculature

Paralysis of limb

Head Position

2o denervation of paraspinous muscle

Normal

Sensation

Absent

Absent

Pain

Deafferentation pain

Lower incidence

Horner’s Syndrome

C8 & T1 Avulsion

Traction injury very close to cord

Tinel’s sign

Absent

Present (unless supraganglionic lesions are present at the same level)

Histamine Triple Test

Vasodilation, wheal & flair

Absent

CT/Myelography

Traumatic pseudomeningoceles, obliteration of root detail

Normal

Electromyography

Paravertebral muscle and limb muscle denervation

Limb Muscle denervation

Nerve conduction

Motor conduction absent, sensory present

Motor and Sensory conduction absent

A image thumb
3

List the nerve transfers to restore Elbow flexion

Donor: UN fascicle of FCU + MN fascicle of FCR/PL/FDS OR Medial Pectoral n, Intercostal, Td, Distal Accessory

Recipient: Biceps brachii, branchialis OR musculocutaneous

4

List the nerve transfers to restore Elbow Extension

Donor: UN fascicle to FCU, Intercostal

Recipient: Triceps RN

5

List the nerve transfers to restore  Shoulder Abduction and external rotation

Donor: SAN, Pectoral fascicle of C7

Recipient: Suprascapular N

6

List the nerve transfers to restore Shoulder Abduction 

Donor: Intercostals, Medial Pectoral branch, Medial Triceps branch, Td

Recipient: Axillary n

7

List the nerve transfers to correct scapular winging

Donor: Td, pectoral fascicle of C7

Recipient: LTN

8

Classify nerve injury

Seddon

Sunderland

Pathology

Structure involved

Recovery pattern

Rate of recovery

 

Neurapraxia

I

Local conduction block

Gross structures intact

 

Complete

Fast

Days to weeks

 

Axonotmesis

 

II

 

Axons undergo Wallerian degeneration

 

Complete

Slow 1mm/day

 

 

 

III

 

Axon, myelin  & endoneurium

Varies depending on endoneurial scarring

Slow 1 mm/day

 

 

IV

 

Axon, myelin, endoneurium & perineurium

Incomplete recovery, neuroma-in-continuity

Nerve Repair or graft

 

Neurotmesis

 

V

Transection of nerve

All (inc epineurium)

 

None

Nerve repair or graft

MacKinnon

VI

Mixed Injury

Components of all the above

 

 

9

How do you classify brachial Plexus injury

By nerve injury type

            - Root avulsion

            - Nerve rupture

            - Neuroma-in-continuity

By location

            - preganglioninc

            - postganglionic

By anatomical structures involved

- roots, trunk, division, cords, branches

 

 

 

10

Describe the MRC muscle grading system

Muscle Grading

Observation

0

No contraction

1

Flicker or trace f contraction

2

Active movement, with gravity eliminated

3

Active movement, against gravity

4

Active movement against gravity and resistance

5

Normal power

11

Describe Erb-Duchenne Palsy

= injury to C5-C6 roots or upper trunk

- Muscles affected: rhomboid, levator scapulae (C5), deltoid, serratus anterior, supraspinatus, infraspinatus, biceps, branchialis, coracobranchialis, brachioradialis, radial wrist extensors, clavicular head of pectoralis

- Functional loss: shoulder abduction, external rotation, elbow flexion, wrist extension

- Sensory loss: lateral arm and thumb/index

12

Describe Erb’s plus deformity

= injury to C5,6,7

- Muscles affected: as in erb duchenne + triceps, ECRL, ECRB, EDC EPL EPB APL

- Functional loss: as in erb duchenne + loss of elbow, wrist, finger extension

- Sensory loss: thumb, index and long fingers

13

Describe Klumpke palsy

= injury to C(7),8,T1

- muscles affected: FPL, FDP, FDS, (EDC/EPL), lumbrical, inteross, hypothenar, thenar

- functional loss: finger and thumb flexion, (thumb finger extension)

- sensory loss: anterior and medial arm, ring and little fingers

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