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.
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.
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