Brachial Plexus Injury PDF

The brachial plexus is a network of nerves that provides movement and feeling to the shoulder, arm and hand. The nerves supporting the arm exit the spinal column high in the neck; those that support the hand and fingers exit lower in the neck. This nerve complex is composed of four cervical nerve...

The brachial plexus is a network of nerves that provides movement and feeling to the shoulder, arm and hand. The nerves supporting the arm exit the spinal column high in the neck; those that support the hand and fingers exit lower in the neck. This nerve complex is composed of four cervical nerve roots (C5-C8) and the first thoracic nerve root (T1). These roots combine to form three trunks. C5-C6 form the upper trunk, C7 continues as the middle trunk and C8-T1 form the lower trunk. Each trunk splits into a division. Half the divisions globally supply flexor muscles (that lift and bend the arm). The others supply the extensor muscles (that straighten the arm and bring it down).  Causes of Brachial Plexus Injury A brachial plexus birth injury ,during the delivery process. This injury may result in incomplete sensory and / or motor function of the involved arm. A brachial plexus injury was found to occur in 1.5 of every 1,000 live births. Traumatic brachial plexus injuries may occur due to motor vehicle accidents, bike accidents, ATV accidents, sports, etc. Nerve injuries vary in severity from a mild stretch to the nerve root tearing away from the spinal cord. Symptoms of Brachial Plexus Injury Patterns of muscle weakness or paralysis of the involved upper extremity depending on which nerves of the brachial plexus are involved Decreased sensation (feeling) in the involved upper extremity Pain  Types of Brachial Plexus Injuries Overview: Brachial plexus injuries can vary widely in severity and nature, depending on the mechanism of injury and the specific nerves affected. They are generally classified based on the type and extent of nerve damage. Avulsion The nerve is torn away from its attachment at the spinal cord; the most severe type. An eyelid droop suggests an avulsion of the lower brachial plexus (Horner's syndrome). Rupture The nerve is torn, but not at the spinal cord attachment. Risk Factors for Brachial Plexus Birth Injury Neuroma Shoulder dystocia (the baby's shoulder being restricted on Scar tissue has grown around the injury site, putting the mother's pelvis) pressure on the injured nerve and preventing the nerve Maternal diabetes from sending signals to the muscles. Large gestational size Neurapraxia Difficult delivery needing external assistance The nerve has been stretched and damaged but not Prolonged labor torn. Breech presentation at birth Over half of brachial plexus Injuries have no known risk factors  Conditions Related to Brachial Plexus Injuries Erb-Duchenne's Palsy Definition : Paralysis of the arm due to injury to the upper brachial plexus nerves (C5-C6). Causes: Birth Trauma: Difficult childbirth, shoulder dystocia. Trauma: Sports injuries, falls, accidents. Symptoms: Muscle Weakness/Paralysis: Affects deltoid, biceps, brachialis. Arm Position: Hangs limply, internally rotated, wrist flexed ("waiter's tip"). Movement Limitation: Difficulty lifting arm, bending elbow. Sensory Loss: Reduced sensation in outer arm and thumb. Treatment: Physical Therapy: Maintains range of motion, prevents stiffness. Occupational Therapy: Improves functional use. Surgery: Nerve grafts/transfers in severe cases. Prognosis: Many infants recover with early intervention.  Klumpke's Palsy Definition : Klumpke's palsy is a type of brachial plexus injury affecting the lower nerve roots (C8-T1). Causes: Birth Trauma: Difficult delivery, breech births. Trauma: Falls, pulling injuries, accidents causing arm hyperextension. Symptoms: Muscle Weakness/Paralysis: Affects muscles of the forearm and hand. Hand Position: Claw hand deformity (hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints). Sensory Loss: Numbness or loss of sensation in the medial aspect of the arm, forearm, and hand (ring and little fingers). Treatment: Physical Therapy: Enhances strength and mobility. Occupational Therapy: Aids in daily functional activities. Surgical Intervention: May be required in severe cases to repair nerve damage. Prognosis: Varies; early intervention improves outcomes.  Axillary Neuropathy Definition : Axillary neuropathy is an injury to the axillary nerve (C5- C6), affecting shoulder movement and sensation. Causes: Shoulder Dislocation: Most common cause. Fractures: Especially of the humerus. Compression: Due to prolonged pressure or improper use of crutches. Symptoms: Muscle Weakness: Particularly in the deltoid muscle, leading to difficulty in lifting the arm. Sensory Loss: Numbness or tingling in the "regimental badge" area of the shoulder. Atrophy: Wasting of the deltoid muscle if the nerve damage is severe and prolonged. Treatment: Physical Therapy: Focuses on exercises to strengthen the shoulder muscles and maintain range of motion. Occupational Therapy: Helps with adapting daily activities to accommodate the weakness. Surgical Intervention: Nerve repair or grafting in severe cases where there is no improvement with conservative management. Prognosis: Recovery can vary, but early treatment improves outcomes. Radial Neuropathy Definition: Radial neuropathy refers to damage or compression of the radial nerve, affecting movement and sensation in the arm and hand. Causes: Fractures: Particularly of the humerus bone in the upper arm. Compression: Prolonged pressure on the nerve, such as during sleep or due to improper positioning. Injury: Direct trauma to the radial nerve, such as in accidents or sports injuries. Symptoms: Wrist Drop: Inability to extend the wrist and fingers, leading to a characteristic drooping of the hand. Weakness: Difficulty with gripping objects or lifting the arm. Sensory Loss: Numbness or tingling along the back of the hand and forearm. Treatment: Splinting: Provides support and prevents further nerve damage during recovery. Physical Therapy: Exercises to improve strength and flexibility in the affected arm. Medications: Pain management medications may be prescribed for associated discomfort. Surgery: Reserved for severe cases or when conservative measures fail to provide relief. Median Neuropathy Definition: Median neuropathy involves damage or compression of the median nerve, affecting sensation and movement in the forearm, hand, and fingers. Causes: Compression: Commonly due to carpal tunnel syndrome, where the median nerve is compressed within the wrist. Fractures: Particularly of the wrist or forearm bones. Repetitive Motion: Activities such as typing or assembly line work can contribute to median nerve irritation. Symptoms: Hand Weakness: Difficulty with pinch grip and thumb opposition. Numbness/Tingling: Along the thumb, index finger, middle finger, and half of the ring finger. Pain: May radiate from the wrist into the hand and fingers, especially at night. Treatment: Splinting: Immobilization of the wrist to relieve pressure on the nerve. Corticosteroid Injections: Reduce inflammation and alleviate symptoms. Physical Therapy: Exercises to improve wrist and hand strength and flexibility. Surgery: Carpal tunnel release for severe or refractory cases. Carpal Tunnel Syndrome Definition: Carpal tunnel syndrome (CTS) is a common condition caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. Causes: Anatomical Factors: Narrowing of the carpal tunnel due to genetics or certain health conditions. Repetitive Motion: Activities involving repeated flexion and extension of the wrist, such as typing or assembly line work. Pregnancy: Hormonal changes can increase fluid retention and lead to swelling, putting pressure on the median nerve. Symptoms: Numbness/Tingling: Predominantly in the thumb, index finger, middle finger, and half of the ring finger. Pain: Burning or aching sensation in the hand, often worsening at night. Weakness: Difficulty with fine motor tasks, such as buttoning a shirt or gripping objects. Treatment: Wrist Splinting: Immobilization of the wrist in a neutral position to alleviate pressure on the median nerve. Corticosteroid Injections: Reduce inflammation and provide temporary relief from symptoms. Physical Therapy: Exercises to improve wrist flexibility and strengthen surrounding muscles. Surgery: Carpal tunnel release to alleviate pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel. Ulnar Neuropathy Definition: Ulnar neuropathy refers to damage or compression of the ulnar nerve, affecting sensation and movement in the forearm, hand, and fingers. Causes: Compression: Often occurs at the elbow (cubital tunnel syndrome) or wrist (Guyon's canal syndrome). Trauma: Direct injury to the ulnar nerve, such as fractures or dislocations. Prolonged Pressure: Leaning on the elbow for extended periods or repetitive activities that strain the nerve. Symptoms: Claw Hand Deformity: Hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints of the ring and little fingers. Weakness: Difficulty with grip strength and fine motor tasks involving the affected fingers. Numbness/Tingling: Along the ring and little fingers, and the ulnar border of the hand and forearm. Treatment: Splinting: Immobilization of the elbow or wrist to reduce pressure on the ulnar nerve. Physical Therapy: Exercises to improve strength and flexibility in the affected arm and hand. Activity Modification: Avoiding activities that exacerbate symptoms or put additional strain on the nerve. Surgical Intervention: Ulnar nerve decompression or transposition in severe or refractory cases.  Diagnosis of Brachial Plexus Injuries Clinical Examination: Assessment of muscle strength, sensation, and reflexes in the affected arm. Observation of any characteristic postures or deformities associated with specific nerve injuries. Provocative tests such as the Tinel's sign or Phalen's test may be performed to elicit symptoms of nerve compression. Imaging Studies: MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, helping to visualize nerve roots and any structural abnormalities. CT (Computed Tomography) Myelography: Injection of contrast dye into the spinal canal followed by CT scanning to assess nerve compression or injury. Ultrasound: Can be used to assess nerve integrity and detect abnormalities such as nerve enlargement or compression. Electrodiagnostic Studies: Electromyography (EMG): Measures the electrical activity of muscles, helping to assess nerve function and detect any abnormalities. Nerve Conduction Studies (NCS): Measures the speed and strength of nerve signals, aiding in the diagnosis of nerve compression or injury. Clinical Correlation: Integration of clinical findings with imaging and electrodiagnostic results to establish a comprehensive diagnosis. Differentiation between various types of brachial plexus injuries based on the pattern of weakness, sensory loss, and reflex abnormalities. Prognosis and Outcomes Factors Influencing Recovery: Severity of the injury Timeliness of treatment Patient’s age and health Possible Outcomes: Full recovery, partial recovery, or permanent disability. https://youtu.be/l5QYT2Ifp18