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1. BRACHIAL PLEXUS EXAMINATION
Introduction
- Exposure:how he openthe shirt? By one hand?
1. LOOK
- Attitude (commenton resting posture of UL)
o Shoulder drop
o Arm: Internal rotation
o Elbow: extended
o Forearm: pronated
o Wrist: flexed
- Muscle wasting
o Forearm muscle smaller?
o Pet major
o Deltoid
o Supraspinatus or infraspinatus
o Biceps
o Triceps
o Flexor extensor
o Thenar/hypothenar
- Scar
o Prev #
o Surgical scar
o Chest tube scar (clue: high energy trauma 
pneumothorax)
o Clavicle deformity
- Any wing scapula
- Horner’s syndrome (pre ganglionic: if -ve no need do myotome
and dermatome)
o M: Miosis (constricted eyelid)
o A: Anhidrosis (rasa peluh kat dahi?)
o P: Ptosis
o L: Loss ciliary reflex
o E: Enopthalmus (sink eyelid : look from lateral)
2. FEEL
- Temperature
- Tenderness
o Clavicle
o Acromion
o Spine of scapula
o Cervical
o Paraspinous

2. 3. MOVE (Dr. KMZ want this first then cont. look) : commentROM
Part Active passive
Finger 0 10?
Wrist 0 10-12?
Elbow 0 45?
Shoulder 0 45?
*Comment: total paralysis of Rt/Lt UL with no active movement
4. NEUROLOGICAL (compare both side for motor)
PERIPHERAL : postganglionic
A. Sensory
Volar
Ulnar:
- Lateral side hypothenar
(High lesion)
Radial:
- First dorsal web space orsnuff’s
box
Dorsal
Median:
- Thenareminence (High
lesion)
- Index finger (Low lesion)
Ulnar:
- Little finger (Low lesion)
B. Motor (mustresistus)
OK sign
● AIN O
● ULNAR ABDUCT AND ADDUCT OF
FINGERS
● RADIAL 
WRIST EXTENSION
● PIN FINGER EXTENSION
Volar
Median:
- 1st
phalange of index finger
(High lesion)
- Thumb up (Low lesion)
Ulnar:
- 1st
phalanx of little finger
(High lesion)
- Abductand adduct fingers
(Low lesion)
Dorsal
Radial:
- Finger and wrist extension
Compressionneuropathy?
- Able to do but weak
- Muscle wasting if chronic and long
term
DERMATOME MYOTOME : pre-ganglionic

3. TONE
- Roll : If muscle wasting hypotonia
MYOTOME (compare right and left)
C5 Elbow flexors
C6 Wrist extensors
C7 Elbow extensors,wrist extension, finger extension
C8 Finger flexor (distal phalanx middle finger)
T1 Finger abductors (little finger)
DERMATOME
*Dx: Rt/Lt pre/post-ganglionic brachial plexus injury of closed/open#
DISCUSSION
Investigations:

4. - Xray: chest, cervical, shoulder
- MRI: to check either pre/post ganglionic
o Don’t do too early as cannot be seen
o If hematoma will confuse and cannot identify BPI
- Nerve conduction study
- EMG
- Histamine test
Treatment:
- TENS: prevent stiffness
- Sx:
o Primary reconstruction (<3m)
▪ Neurotization: spinous acc suprascapular
● Functioning nerve to non-functioning nerve
▪ Interpositional: sural  intercostal  for
musculocutaneous nerve (extra plexus)
o Secondary reconstruction (3-6m)
▪ Tendon transfer
▪ Free functioning muscle transfer(usually use gracilis
muscle)
▪ shoulder arthrodesis
▪ Wrist & hand arthrodesis
PRIORITY
1. Elbow flexion
2. Shoulder
3. Hand (most difficult)
4. Wrist extension and finger flexion
5. Wrist flexion