Peripheral nerve injuries about the shoulder

Question 1

Suprascapular

Answer 1

C5-6
Supraspinatus/infraspinatus
Top of shoulder from clavicle to spine of scapular (sensory)
Pain in posterior shoulder
Seen in people who work with arms OH or in cocking/follow through
Suprscapular notch: paralysis of supraspinatus (abduction) and Infra (LR)
Fibro-osseous tunnel by spinoglenoid ligament: infraspinatus only

Question 2

Axillary (circumflex)

Answer 2

C5-6
Deltoid, Teres minor
Sensory: deltoid area, anterior shoulder pain
MOI: anterior GH dislocation; fracture of surgical neck of humerus
Inability to abduct arm with neutral rotation; weakness in LR
Flattening of shoulder
Most commonly injured nerve

Question 3

Radial

Answer 3

C5-C8, T1
Triceps, wrist extensors, finger extensors
Sensory: dorsum of hand
Reflex: triceps
MOI: fx of humeral shaft; crutch palsy

Question 4

Long Thoracic Nerve

Answer 4

C5-7 Rucksack palsy
Serratus anterior
MOI: compression (backpack injury); heavy effort above shoulder height (shoveling/chopping)
Pain on fully extended arm while flexion shoulder
Winging medially at 90 degrees FF; abduction > 90 degrees difficult
2 year recovery

Question 5

Musculocutaneous

Answer 5

C5-C7
Coracobrachialis, biceps, brachialis
Sensory: lateral aspect of forearm
MOI: fx of clavicle, anterior dislocation; putti platt surgery; bankart
Weak elbow flexion with forearm supination; loss of shoulder flexion

Question 6

Musculocutaneous nerve tunnel syndrome

Answer 6

alterned sensation in anterolateral aspect of forearm due to antebrachial cutaneous nerve branch being compressed as it passes distal biceps tendon; due to forced elbow extension or repeated pronation
Misdiagnosed as tennis elbow

Question 7

Spinal Accessory Nerve

Answer 7

CN XI/ C3-4
trapezius (elevation of shoulder)
brachial plexus symptoms due to drooping of shoulder
MOI: traction (shoulder depression and neck rotation to opposite side)
Inability to abduct > 90 degrees with pain; scapular winging with medial rotation of inferior angle especially with abduction
Deepening of supraclavicular fossa due to trapezius atrophy
SCM is spared
Sx = eden lange procedure where levator scap is transferred to acromion and rhomboids are transferred to infraspinatus fossa

Question 8

Subscapular nerve

Answer 8

Posterior cord C5-6
Subscapularis, teres major
Medial rotation

Question 9

Dorsal scapular nerve

Answer 9

C5
Levator scap, rhomboids
Scapular retraction and elevation

Question 10

Lateral pectoral nerve

Answer 10

C5-7

Pectoralis major and minor

Question 11

Thoracodorsal nerve

Answer 11

C6-8

Lats

Question 12

Supraclavicular nerve

Answer 12

Sensory

Mild clavicular pain; sensory loss over anterior shoulder