This document describes different types of brachial plexus injuries including their causes, affected muscles, and resulting clinical presentations. It discusses upper trunk/Erb-Duchenne palsy which affects arm abduction and rotation due to forces during difficult labor. Lower trunk/Klumpke paralysis affects hand muscles leading to clawing due to cervical rib compression. Complete brachial plexus avulsion results in sensory loss in the entire arm except the shoulder tip and axilla, with motor loss in all arm muscles except trapezius and levator scapulae.

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.