After completion of this session, students should be able to discuss, identify, and describe: The anatomical factors predisposing to nerve injuries. The anatomy of deformity, weakness and sensory loss following the nerve injury. The applied anatomy of clinical examination for specific nerves. Surgical anatomy of treating nerve injuries.

1. Dr.AkramJaffar
Applied Anatomy of Nerve Injuries in the Upper LimbApplied Anatomy of Nerve Injuries in the Upper Limb
Upper brachial plexusUpper brachial plexus
Akram Jaffar, Ph.D.
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2. Dr.AkramJaffar
References and suggested reading
• Ellis H (2006): Clinical anatomy, A revision and applied anatomy for clinical students.
11th
Ed. Blackwell Publishing. Massachusetts
• Moore KL & Dalley AF (2006): Clinically oriented anatomy. 5th
ed. Lippincott Williams
& Wilkins. Baltimore
• Brust JCM (2007): Current Diagnosis & Treatment in Neurology. 2nd
ed. McGraw-Hill
Professional.

3. Dr.AkramJaffar
Objectives
After completion of this session, students should be able to discuss, identify, and describe:
– The anatomical factors predisposing to nerve injuries.
– The anatomy of deformity, weakness and sensory loss following the nerve injury.
– The applied anatomy of clinical examination for specific nerves.
– Surgical anatomy of treating nerve injuries.

4. Dr.AkramJaffar
Upper brachial plexus injury
• Erb-Duchenne palsy:
• Results from excessive displacement of the head to the opposite side and depression
of the shoulder on the same side.
Difficult labour Motorcycle fall
Malposition of the upper
limb on the operation table

5. Dr.AkramJaffar
Upper brachial plexus injury
• Erb-Duchenne palsy:
• Also produced by a stab or bullet wound in the neck affecting the superior trunk of the
brachial plexus
Neck wound
Superior trunk

6. Dr.AkramJaffar
Upper brachial plexus injury
• Erb-Duchenne palsy:
• Affects C5 & C6 roots or the superior
trunk
• Nerves affected:
– Suprascapular nerve:
supraspinatus, infraspinatus, teres
major.
– Nerve to subclavius: subclavius.
– Musculocutaneous nerve: biceps,
brachialis and coracobrachialis
(BBC).
– Axillary nerve: deltoid and teres
minor.
• Movements affected: Abduction and
lateral rotation at the shoulder and
flexion at the elbow.
C5
C6
Superior trunk
Suprascapular n.
Subcalvius n.
Musculocutaneous n.
axillary n.

7. Dr.AkramJaffar
Upper brachial plexus injury
• Erb-Duchenne palsy:
• Waiter’s tip position:
• The limb hangs by the side adducted and medially
rotated by unopposed pectoralis major.
• The forearm extended and pronated because the
action of biceps is lost.
Waiter’s tip position