Published on November 2, 2018
1. Prepared By: Rayan Saleh Al-Humaid
2. • Describe Brachial Plexus injuries regarding to :- • Causes • The defect caused by them
3. • According to the side of brachial plexus they divide into two types of injuries:- • Upper trunk injuries • Lower trunk injuries • Whole Plexus injuries
4. • Upper trunk injuries OR (Erb-Duchenne palsy) • In case of excessive displacement of the head & shoulders in 2 opposite directions. Pressure of forceps used in difficult labor.
5. • Erb-Duchenne palsy affected muscles:- • Supraspinatus &Deltoid (loss of abduction of the arm)so the arm is adducted. • Infraspinatus &Teres Minor (loss of lateral rotation )so the arm is medially rotated.
6. • Erb-Duchenne palsy affected muscles:- • Brachialis &Biceps Brachii (loss of flexion at the elbow) so the elbow is extended. • Biceps & Supinator (loss of supination of the forearm) so the forearm is pronated.
7. • Erb-Duchenne palsy the result:- • Upper limb is adducted and medially rotated with the elbow extended and pronated forearm. (police man`s tip position) Sensory loss over lower part of deltoid and lateral side of the forearm.
8. • Lower trunk injuries OR (Klumpke paralysis) • In case of excessive abduction of the arm difficult labor OR presence of cervical rib.
9. • Klupmke paralysis affected muscles:- • Motor effect: paralysis of all intrinsic muscles of the hand mainly lumbricals and interossei
10. • Klupmke paralysis the result:- • loss of flexion of metacarpophalangeal joints& loss of extension of the interphalmgeal joints. • The deformity (complete claw hand) • Due to hyperextension of the metacarpophalangeal joints and flexion of interphalngeal joints.
11. • Klupmke paralysis the result:- • Sensory loss :on the medial of arm ,forearm ,hand and medial 2 fingers • Autonomic loss : due to the affection of ventral ramus of 1st thoracic nerve leading to Horner’s Syndrome (ptosis,miosis enophthalmos and anhydrosis )
12. • Injury of the WHOLE trunks of the brachial plexus OR avulsion (tear) of the brachial plexus. In case of rotation of baby’s shoulders in the birth canal during delivery.
13. • Avulsion of the brachial plexus effects:- • Sensory: Whole upper limb EXCEPT the tip of shoulder (supplied by supraclavicular nerve)& floor of axilla (supplied by T2 nerve). • Motor: All muscles of the upper limb EXCEPT TWO MUSCLES” Trapezius and levator scapulae
14. • Picture of muscle taken from Grants-Atlas-of-Anatomy-13th. • This presentation adapted from Dr.Ahmmad Alzainy lecture.