Brachial plexus injury
Background
Brachial plexus surrounding the brachial artery.
Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.
Dermatomes and cutaneous nerves - anterior
Dermatomes and cutaneous nerves - posterior
- Injuries can be penetrating, compression, or closed traction:
- Supraclavicular (roots and trunks)
- Infraclavicular (cords and terminal nerves)
Anatomy[1]
- Roots:
- C5
- C6
- C7
- C8
- T1
- Trunks:
- Upper
- Middle
- Lower
- Cords:
- Lateral
- Posterior
- Medial
- Terminal Nerves:
- Musculocutaneous
- Median
- Axillary
- Radial
- Ulnar
Clinical Features
Simulated mechanism of injury.
- Arm pain (constant, burning)
- C5 injury:
- weakness of deltoid and infraspinatus causes adducted, internally rotated shoulder
- C6 injury:
- weakness of biceps causes elbow extension
- C7 injury:
- weakness of extensor muscles causes wrist and digit flexion
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
- Clinically evaluate for concurrent phrenic nerve injury and diaphragmatic paresis
- MRI
- CT myelography
- EMG
- Surgical exploration
Management
- Early neurosurgical consultation
- PT / OT
See Also
- Spinal cord levels
- Neurologic Exam
References
- Tintinalli. Emergency Medicine. 7th Edition, 2011.
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