Upper Brachial Plexus Injuries Investigation

After examination of brachial plexus  through our previous scheme of examining Brachial

Plexus , students have to know further detail about diagnosis and  management of different Brachial

Plexus Injuries. Its discussed below.


Upper Plexus Palsy (Erb's Palsy )

 C5-6     +/-  C7 Injury

Typical Position and  attitude of upper limb

         Elbow extended , shoulder Internally rotated , and adducted

         flacid rt side of trunk

Movement of Upper Limbs impairment
       
         Shoulder ROM - Abduction not possible

                                            due to paralysis of Deltoid and Supraspinatus

                                      External Rotation not  possible

                                            due to paralysis of Infraspinatus and Teres Minor

                                       Flexion  not possible

                                              due to paralysis of Biceps , Brachialis , Brachioradialis


            Forearm
                                         Supination not possible

                                           due to paralysis of supinator muscle



Neurological impairments


          Sensation absent over C5-6 myotome


          Paralysis of Long Thoracic Nerve and Dorsal Scapular Nerve leading to Winging of Scapula

       
Investigations

           Myelography

                   delay to 6 -12 weeks

                blood clot occlude opening to cord leading to pseudomeningocele

   CT with enhancements -overestimates root avulsion injury and dye extravasation if used early.

     MRI preferred

    Post Myelograph MRI and CT are mainstay of imaging in brachial plexus injuries.

Cutaneous Axonal Reflexes

          post ganglionic - no flare

          recovery possible after repair.



Upper Plexus after ruling out root avulsion exploration justified, repair sometimes possible.


Treatment part will be covered on next section.