Brachial Plexus Injuries

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.