Brachial plexus injuries can cause damage to the nerves that control the arm and hand. There are several types of injuries ranging from nerve avulsion or detachment from the spinal cord to nerve stretching or tearing. Symptoms depend on the location and severity of the injury but often include weakness, numbness, loss of movement, and pain. Neurological examination assesses factors like muscle tone, strength, reflexes, and sensation to determine which nerves are affected and the severity of the injury.

1. BRACHIAL PLEXUS INJURIES

2. BRACHIAL PLEXUS

5. TYPE OF INJURIES
• Avulsion :
• The nerve root has been pulled out of the spinal
cord
• The most severe brachial plexus injury
• Injuries may not be repairable with standard
surgeries
• Stretch (Neuropraxia) :
• The nerve is mildly stretched
• It may heal on its own or nonsurgical treatment
method
• Rupture :
• More forceful stretch of the nerve may cause it to
tear partially or fully
• Injuries can sometimes be repaired with surgery.

6. UPPER- TRUNK PALSY INJURY
• Occurs when the angle between the shoulder
and the neck forcibly widens :
• Fall forces the shoulder down and the head to the
opposite side
• Impaired shoulder abduction, external
rotation and elbow flexion + waiter’s tip
• Decreased sensation in the shoulder, outside
of the arm, thumb and index finger
• Called as erb’s palsy

7. LOWER- TRUNK PALSY INJURY
• Occurs when the angle between the arm and
the chest wall forcibly widens :
• Stretch the arm as the patient falls with the arm
grasping the tree
• Lose hand function, but still maintain shoulder
and elbow strength  claw position
• Decreased sensation at the least the ring
finger and small finger
• Called as klumpke’s palsy

8. PAN- PLEXUS PALSY INJURY
• Occurs if the force of the injury is extreme
• All levels of the nerves and trunk are damaged
• Complete paralysis of the arm and hand  “flail limb”

9. SYMPTOMS
• Depend on the type and location of the injury to the
brachial plexus
• The most common symptoms :
• Weakness or numbness
• Loss of sensation
• Loss of movement (paralysis)
• Neuropathic pain

10. NEUROLOGICAL EXAMINATION
Appearance
• Some neurological disorders result in postures
 characteristic  can help to diagnostic
• Upper- trunk palsy injury  waiter’s tip
• Lower- trunk palsy injury  claw hand
• Radial nerve palsy  drop wrist

11. NEUROLOGICAL EXAMINATION
Motor Function
1. Muscle tone :
• Assessed by feeling the muscle’s resistance to passive stretch
• Shoulder abduction (C5)
• Elbow flexion (C6) – extension (C7)
• Wrist flexion (C7) – extension (C6)
• Finger flexion (C7, C8, T1) - extension (C7) – abduction and adduction (C8, T1)
• Forearm supination (C5, C6) – pronation (C6)
• Increased tone  spasticity  UMN
• Decreased tone  flaccidity  LMN

12. NEUROLOGICAL EXAMINATION
Motor Function
2. Power :
• Assessed by feeling the muscle’s resistance to active stretch
• Shoulder abduction (C5)
• Elbow flexion (C6) – extension (C7)
• Wrist flexion (C7) – extension (C6)
• Finger flexion (C7, C8, T1) - extension (C7) – abduction and adduction (C8, T1)
• Forearm supination (C5, C6) – pronation (C6)
• Medical Research Council Scale :
• Grade 0  No movement
• Grade 1  Only a flicker of movement
• Grade 2  Movement with gravity eliminated
• Grade 3  Movement against gravity
• Grade 4  Movement against resistance
• Grade 5  Normal power

13. NEUROLOGICAL EXAMINATION
Motor Function
3. Reflexes :
• Deep tendon reflex is elicited by rapidly stretching the tendon near its insertion
• Starting with the most forceful and reducing the force  finer gradations of
response aren’t missed
• Upper Limb :
• Biceps tendon reflex (C5, C6)
• Brachioradialis tendon reflex (C6, C7)
• Triceps tendon reflex (C7, C8)
• Scale of grading :
• Grade 4+  Clonus
• Grade 3+  Brisker than average
• Grade 2+  Normal
• Grade 1+  Low normal
• Grade 0  No respone

14. NEUROLOGICAL EXAMINATION
Sensory Function – Skin sensibility
• Sensibility to touch can use cotton and pinprick or temperature recognition
and two point discrimination
• Based on dermatomal pattern of innervation