Injuries
Injuries of brachial plexus
• Long thoracic nerve
– Damage to serratus anterior
– Wining of scapula
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Injuries of brachial plexus
• Upper brachial plexus damage could be
caused by fall from above because of an
accident (above) or excessive stretching
during delivery.
Upper brachial plexus
• The most common damaged spinal components are C5
and C6. The spinal nerves may be yanked out of the
spinal cord. Muscles that could be affected: Deltoid
(abduction, axillary nerve, C5, 6), Infraspinatus (lateral
rotation, suprascapular nerve, C(4), 5, 6 ), Teres minor
(lateral rotationAxillary nerve, C5, 6), Subscapularis
(medial rotation, upper and lower subscapular nerve, C5,
6, 7), Coracobrachialis (musculocutaneous - C6, 7),
Biceps Brachii (musculocutaneous nerve - C5, C6),
Brachialis (musculocutaneous nerve + a small branch of
radial nerve - C5, C6) , supernator (radial nerve C5, C6,
C(7)), also extensors are affected more by flexors.
Typical position: arm hangs by the sides in medial
rotation.
Lower brachial plexus
• Lower brachial plexus damage can be
caused by forceful pull of upper limb
during birth, Or by grasping a limb during
falling
Lower brachial plexus
• Lower brachial plexus (inferior trunk, C8,
T1) may be affected. Symptoms are
mostly related to the injury of ulnar nerve,
i.e. impairment of wrist flexion and digital
movements
Radial nerve damage
• Poorly fitted crutches (too long) may injure the
posterior cord of the brachial plexus. Often only
the radial nerve is affected. As a result, the
triceps, anconeus, and the extensor muscles of
the wrist are paralyzed (brachioradialis, extensor
carpi radialis longus, extensor carpi radialis
brevis, extensor digitorum, extensor digiti minimi,
extensor carpi ulnaris, Supinator, abductor
pollicis longus, extensor pollicis brevis, extensor
pollicis longus, extensor indicis) -- a condition
referred as wrist drop.
Median nerve damage
• Median nerve damage at hand (as in
carpal tunnel syndrome):
Abductor pollicis brevis, Flexor pollicis
brevis, Opponens pollicis, Lumbricals I, II
Median at arm
• Median nerve damage at arm
• Pronator teres, Flexor carpi radialis,
Palmaris longus, Flexor digitorum
superficialis, Flexor digitorum profundus, I,
II, Flexor pollicis longus, Pronator
quadratus
Ulnar at hand
• Ulnar nerve damage at hand:
• Adductor pollicis, Abductor digiti minimi,
Flexor digiti minimi brevis, Opponens digiti
minimi, Lumbricals III, IV, Dorsal interossei
1-4, Palmar interossei
Ulnar at hand
• Ulnar nerve damage at arm:
• Palmaris brevis, Flexor carpi ulnaris,
Flexor digitorum profundus, III, IV,
Other branches
• thoracodorsal nerve (C6, 7, 8): Latissimus
Dorsi
• dorsal scapular, C4, 5: Rhomboids
• Long thoracic, C5, 6, 7, 8: Serratus
anterior
• suprascapular nerve, C(4), 5, 6:
Infraspinatus, Supraspinous muscle
• axillary nerve, C5, 6: Deltoid, Teres minor
Carpal tunnel syndrome
• Any lesion that significantly reduce the size of the
carpal tunnel formed by flexor retinaculum (e.g.,
inflammation, arthritis, dislocation) may cause
the compression of median nerve. Early
symptoms include: tingling (paresthesia),
absence of tactile sensation (anesthesia), or
diminished sensation (hypoesthesia) in the digits.
Since median nerve sends a palmar cutaneous
branch superficial to the flexor retinaculum, so
the sensory impairment of palm is rarely seen.
Most patients are 40-60 years old and more
common in women, some caused by pregnancy.
Carpal tunnel syndrome
• There is often a progressive loss of coordination
and strength in the thumb, owing to the
weakness of abductor pollicis brevis and
opponents pollicis. In severe cases of
compression of median nerve, there may be
wasting or atrophy of the thenar muscles. Partial
or complete division of flexor retinaculum (carpal
tunnel release) is the cure. Medical approach
includes: split, cortisol shot, resolve after
delivery.
Elbow tendonitis (tennis elbow, lateral
epicondylitis)
• Elbow tendonitis is a painful musculoskeletal condition
that may follow repetitive forceful pronation-supination of
the forearm. Clinical symptoms include pain and point of
tenderness at or distal to the lateral epicondyle of the
humerus and it is caused by the premature degeneration
of the common extensor attachment of the superficial
extensor muscles of the forearm. Commonly seen in
persons who play tennis because of the repeated
strenuous contraction of the extensor muscles,
especially during the backhand stroke. These
movements strain the common extensor tendon of these
muscles and produce inflammation of the lateral
epicondyle. Treatment options are: immobilization, anti-
inflammatory drugs, and surgical (tendon, bone,
removal, de-re-attachment of muscles)
Other conditions
• Fracture of radius
– Radial styloid process fracture
Rotator cuff muscles
• Four muscles
– Supraspinatus
– Infrespinatus
– Teres minor
– Subscapularis
Mallet or Baseball Finger
• Sudden extreme flexion of interphalangeal
joint
Subluxation and Dislocation
• Preschoolers, especially girls vulnerable
• “Pulled elbow”