Brachial plexus injury

Background

• Anatomy:
  • Roots:
    • C4
    • C5
    • C6
    • C7
    • T1
  • Trunks:
    • Upper
    • Middle
    • Lower
  • Cords:
    • Lateral
    • Posterior
    • Medial
  • Terminal Nerves:
    • Musculocutaneous
    • Median
    • Axillary
    • Radial
    • Ulnar
• Injuries can be penetrating, compression, or closed traction:
  • Supraclavicular (roots and trunks)
  • Infraclavicular (cords and terminal nerves)

Clinical Features

• Arm pain (constant, burning)
• C5 injury:
  • weakness of deltoid and infraspinatus causes adducted, internally rotated shoulder
• C6 injury:
  • weakness of biceps causes elbow extension
• C7 injury:
  • weakness of extensor muscles causes wrist and digit flexion

Diagnosis

• MRI
• CT myelography
• EMG
• Surgical exploration

Management

• Early neurosurgical consultation
• PT / OT