Brachial plexus injuries

Question 1

What is an injury to the upper roots of the brachial plexus called?

Answer 1

Erb’s palsy

Question 2

How might an upper brachial plexus injury arise?

Answer 2

Excessive increase in angle between neck + shoulder
Trauma
Shoulder dystocia/impacted shoulders in pelvis in birth + excessive traction applied to baby’s neck

Question 3

What roots are affected in an upper brachial plexus injury?

Answer 3

C5 + C6

Question 4

What are the effects of an upper brachial plexus injury?

Answer 4

Loss of movements through C5 + 6 myotomes

Paralysed muscles = deltoid/teres minor/biceps brachii/brachioradialis/brachialis/coracobrachialis

Question 5

What position will the patient be in in an upper brachial plexus injury?

Answer 5

Waiters tip

Limb by side in medial rotation, adducted arm, extended elbow

Question 6

What is an injury to the lower roots of the brachial plexus called?

Answer 6

Klumpke’s palsy

Question 7

How does a lower brachial plexus injury arise?

Answer 7

Forced hyperextension or hyperabduction
Fall from height + grab onto tree branch on way
Baby’s arm delivered 1st, traction applied to arm to deliver rest of baby

Question 8

What roots are affected in a lower brachial plexus injury?

Answer 8

C8 + T1

Question 9

What are the effects of a lower brachial plexus injury?

Answer 9

Weakened myotomes of C8 + T1
Paralysis of intrinsic muscles of hand/flexors of forearm supplied by ulnar nerve/muscles supplied by C8 + T1 fibres within median + radial nerves

Question 10

What position is a lower brachial plexus injury held in?

Answer 10

Claw hand
Hyperextension of all MCPJ (ulnar nerve injury = only ring + little finger)
Flexion of interphalangeal joints
Abduction of thumb
Wasting of interossei