Brachial plexus injury

Background

Brachial plexus surrounding the brachial artery.
Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.
Nerve roots that supply sensation to the upper extremities.
  • Injuries can be penetrating, compression, or closed traction:
    • Supraclavicular (roots and trunks)
    • Infraclavicular (cords and terminal nerves)

Causes of Brachial plexopathy

Anatomy[1]

  • Roots:
    • C5
    • C6
    • C7
    • C8
    • T1
  • Trunks:
    • Upper
    • Middle
    • Lower
  • Cords:
    • Lateral
    • Posterior
    • Medial
  • Terminal Nerves:
    • Musculocutaneous
    • Median
    • Axillary
    • Radial
    • Ulnar

Clinical Features

Simulated mechanism of injury.
  • 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

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Upper extremity peripheral nerve syndromes

Median Nerve Syndromes

Ulnar Nerve Syndromes

Radial Nerve Syndromes

Proximal Neuropathies

Other

Evaluation

  • Clinically evaluate for concurrent phrenic nerve injury and diaphragmatic paresis
  • MRI
  • CT myelography
  • EMG
  • Surgical exploration

Management

  • Early neurosurgical consultation
  • PT / OT

Disposition

See Also

External Links

References

  1. Tintinalli. Emergency Medicine. 7th Edition, 2011.