Brachial plexus injuries

Question 1

Prevalence of Complete lesions : involving all the roots of the Brachial plexus ?

Answer 1

Rare

Question 2

Complications of a Complete lesion ; involving all the roots of the Brachial plexus ?

Answer 2

-Result in complete paralysis of all limb muscles except (Trapezius)

• Complete loss of sensation except : (on upper half of deltoid) and (floor of axilla)

Question 3

Erb Duchenne palsy ?

Answer 3

Upper trunk lesion of the Brachial plexus ; at erb’s point C5,C6

Question 4

Name the common Brachial plexus injury ; that is a complication of brachial plexus stretching during delivery

Answer 4

Upper trunk lesion : Erb Duchenne palsy

Question 5

Nerves affected in : Erb Duchenne palsy ?

Answer 5

-Nerve to subclavius

-Suprascapular nerve

-Axillary nerve

-Musculocutaneous nerve

Question 6

Presentation of Erb Duchenne palsy ?

Answer 6

The limb is adducted, medially rotated and pronated:

”waiter ’s tip” deformity ;

+loss of sensation down the lateral side of the arm.

Question 7

Name the Brachial plexus injury : associated with excessive abduction or traction of arm

Answer 7

Lower trunk lesion : Klumpke’ s paralysis

Question 8

Brachial roots affected in Klumpke’ s paralysis ?

Answer 8

C8 and T1

Question 9

Paralysis associated with “Klumpke’ s paralysis” ?

Answer 9

-Paralysis of interossei and lumbricals

-Paralysis of flexor carpi ulnaris ;

-and ulnar half of flexor digitorum profundus

Question 10

Major presentation of Klumpke’ s paralysis ?

Answer 10

-Claw hand and ;

-Horner syndrome (T1 affection)

Question 11

A common cause of : Suprascapular nerve lesion ?
(Not plexus related)

Answer 11

Entrapment

Question 12

Complications of Suprascapular nerve lesion ?

Answer 12

-Wasting

-Weakened abduction and lateral rotation

Question 13

Causes of : Long thoracic nerve lesion ?

Answer 13

-During mastectomy

-Carrying heavy object on shoulder

-Chest tube insertion

-Stab wound

Question 14

Complications of : Long thoracic nerve lesion ?

Answer 14

-Winging of scapula

-Difficulty raising arm above shoulder

Question 15

Name the condition , and the nerve injury associated with it

Answer 15

Shoulder dislocation ;

• Axillary nerve palsy

Question 16

Two major causes : of Axillary nerve palsy ?

Answer 16

-Surgical neck fracture of the humerus

-Shoulder dislocation

Question 17

Presentation of Axillary nerve palsy ?

Answer 17

-Wasting of deltoid

-Weakened abduction

Question 18

Causes of Median nerve injury at elbow ?

Answer 18

-Supracondylar fracture

-Entrapment (Struther ’s ligament)

Question 19

Define the lesion and the nerve injury associated with it

Answer 19

Supracondylar fracture ;

• Median nerve injury

Question 20

Define the lesion and the nerve injury associated with it

Answer 20

Entrapment by (Struther ’s ligament) ;

• Median nerve injury

Question 21

Motor complications of : Median nerve injury at elbow ?

Answer 21

-Hand of benediction

-Ape hand deformity

-Loss of pronation and weak wrist

Question 22

Sensory complications associated with : Median nerve injury at elbow ?

Answer 22

Question 23

Causes of Median nerve injury at wrist ?

Answer 23

• Colle’s fracture

-Stab wound

Question 24

Define the condition and the nerve injury associated

Answer 24

Colle’s fracture ;

• Median nerve injury at wrist

Question 25

Define the condition and the nerve injury associated

Answer 25

Carpal tunnel syndrome

Question 26

Major causes of Carpal tunnel syndrome ?

Answer 26

•arthritic changes (arthritis) •tenosynovitis •Carpal dislocation •diabetes •thyroid dysfunction •fluid retention from pregnancy

Question 27

A common occupational cause of : Carpal tunnel syndrome ?

Answer 27

Typing :

Question 28

Presentation of Carpal tunnel syndrome ?

Answer 28

1. burning pain or “pins and needles” followed by sensory loss 2. weakness and flattening

Question 29

Treatment of Carpal tunnel syndrome ?

Answer 29

The condition is dramatically relieved by decompressing the tunnel making a longitudinal incision through the flexor retinaculum

Question 30

….. is a nerve of no cutaneous or motor branches in the axilla or in the arm

Answer 30

The ULNAR NERVE

Question 31

Root value of ulnar nerve ?

Answer 31

• The ulnar nerve arises from the medial cord of the brachial plexus (C7, C8 and T1)

Question 32

Causes of : Ulnar Nerve lesion at elbow ?

Answer 32

-Supracondylar fracture -Medial epicondyle fracture -Entrapment (cubital tunnel)

Question 33

Paralysis associated with : Ulnar Nerve lesion at elbow ?

Answer 33

1. Flexor carpi ulnaris: week flexion of wrist with radial deviation 2. Medial ½ of flexor digitorum profundus: no flexion at distal interphalyngeal joints of 4 th and 5 th finger 3. Hypothenar muscles: atrophy 4. Interossei 5. Adductor pollicic: loss of adduction of thumb

Question 34

Motor presentation of Ulnar Nerve lesion at elbow ?

Answer 34

-Incomplete claw hand ; +flattening of hypothenar eminence +hollowing between metacarpal bones due to wasting

Question 35

Sensory loss associated with : Ulnar Nerve lesion at elbow ?

Answer 35

Sensory loss: -Palmar cutaneous branch -Palmar digital branch -Dorsal cutaneous branch

Question 36

Vasomotor changes associated with : Ulnar Nerve lesion at elbow ?

Answer 36

loss of sympathetic control >> warm, dry skin

Question 37

Trophic changes associated with : Ulnar Nerve lesion at elbow ?

Answer 37

dry, scaly, atrophy of pulp, cracking nails

Question 38

Causes of : Ulnar Nerve lesion at wrist ?

Answer 38

Cut and Stab wound (Guyon’s canal)

Question 39

Motor affection associated with : Ulnar Nerve lesion at wrist ?

Answer 39

Same as lesion at elbow ,, but forearm muscles are spared

Question 40

Compare between the severity of deformity seen in : Ulnar nerve injury at elbow/vs/ at wrist

Answer 40

Worse at wrist

Question 41

Why is the incomplete claw hand worse in ulnar nerve injury at wrist ?

Answer 41

due to contraction of distal interphalangeal joints of 4 th and 5 th digits

Question 42

Sensory loss associated with : Ulnar Nerve lesion at wrist ?

Answer 42

Same except dorsal aspect of palm and proximal phalanges are spared

Question 43

Summarize ulnar nerve injury at elbow

Answer 43

1- Weak flexion 2- Loss of wrist adduction 3- Inability to adduct thumb 4- Inability to put the hand in writing position - Sensory loss - Partial claw hand deformity

Question 44

Summarize ulnar nerve injury above wrist

Answer 44

1- No Weak flexion 2- No Loss of adduction 3- Inability to adduct thumb 4- Inability to put the hand in writing position - Sensory loss to fingers only - Partial claw hand deformity is more prominent (Ulnar paradox)

Question 45

Common causes of Radial nerve injury at axilla ?

Answer 45

Question 46

Complications of Radial nerve injury at axilla ?

Answer 46

Question 47

Two causes of Radial nerve injury at spiral groove ?

Answer 47

- Humeral fractures at spiral groove - Posterior interosseous nerve entrapment

Question 48

Name the hidden structure and mention the condition in which it can be injured

Answer 48

Posterior interosseous nerve entrapment >> proximal radial nerve injury