Brachial Plexus Injuries

1. Brachial Plexus Injuries Professor Muhammad Rafique

2. Typical Spinal Nerve

3. Assisted Labor

4. Difficult Labor

5. Breech Presentation

6. Parturition During the process of delivery a slight force is applied at the head to drag the baby out of the birth canal. If the force is severe it may damage the brachial plexus More common on right side and usually upper roots C5 and C6 and sometime C7 roots injured

7. Sing

8. Symptoms

9. Begin with a letter “Y”, an “I” and a “Y”.

10. Add a “strike” and a “spare” (bowling scorekeeping symbols)

11. Draw “arches”.

12. Draw horizontal lines to separate the parts. Roots Trunks Divisions Cords Branches

13. Roots Trunks Divisions Cords Branches Begin labeling. C5 C6 C7 C8 T1 Upper Middle Lower Medial Lateral Posterior SLOW Axillary Median Radial Ulnar Musculocutaneous

14. Roots Trunks Divisions Cords Branches Add details . . .Branches off the posterior cord spell “ULTRA” C5 C6 C7 C8 T1 Upper Middle Lower Lateral Medial Posterior Upper subscapular Lower subscapular Thoracodorsal SLOW SLOW Musculocutaneous Axillary Median Radial Ulnar

15. Roots Trunks Divisions Cords Branches “3M” comes off the medial cord. C5 C6 C7 C8 T1 Middle Lower Upper Posterior Lateral Medial Upper subscapular Medial pectoral n. Lower subscapular Medial cutan. n. of arm Thoracodorsal Medial cutan. n. forearm SLOW SLOW Axillary Median Radial Ulnar Musculocutaneous

16. The lateral pectoral n. comes off the lateral cord. C5 C6 C7 C8 T1 Roots Upper Middle Lower Trunks Divisions Posterior Medial Lateral Cords Upper subscapular Medial pectoral n. Lower subscapular Medial cutan. n. of arm Thoracodorsal Medial cutan. n. forearm Branches Axillary Median Radial Ulnar Musculocutaneous Lateral pectoral n.

17. There are 4 supraclavicular branches. C5 C6 C7 C8 T1 Roots Long Thoracic n. Dorsal Scapular n. Upper Middle Lower N. to subclavius Trunks Suprascapular n. Divisions Posterior Lateral Cords Medial Upper subscapular Medial pectoral n. Lateral pectoral n. Lower subscapular Medial cutan. n. of arm Thoracodorsal Medial cutan. n. forearm Branches SLOW Axillary Median Radial Ulnar Musculocutaneous

18. Roots Trunks Divisions Cords Branches That’s it! The Brachial Plexus C5 C6 C7 C8 T1 Long Thoracic n. Dorsal Scapular n. Upper Middle Lower N. to subclavius Suprascapular n. Posterior Lateral Medial Upper subscapular Medial pectoral n. Lateral pectoral n. Lower subscapular Medial cutan. n. of arm Thoracodorsal Medial cutan. n. forearm Axillary Median Radial Ulnar Musculocutaneous

19. Different Parts of Brachial Plexus in Relation to Clavicle Supra-Clavicular Part • Roots, Trunks Retro-Clavicular Part • Divisions Infra-Clavicular Part • Cords, Branches

20. Relation of Cords of Brachial Plexus with Axillary Artery • Axillary Artery divided into three parts 1st, 2nd and 3rd part by means of Pectoralis minor muscle. • The cords of brachial plexus surround the axillary artery. • On the 2nd part of axillary artery the cords of brachial are lying lateral, medial and posterior, that’s why they are named

21. Causes of Brachial Plexus Injuries A birth brachial plexus injury is thought to be caused by an injury involving the child's brachial plexus during the delivery process. This injury results in incomplete sensory and / or motor function of the involved arm. Traumatic brachial plexus injuries may occur due to motor vehicle accidents, bike accidents, ATV accidents, sports, etc. Nerve injuries vary in severity from a mild stretch to the nerve root tearing away from the spinal cord.

22. Causes of Brachial Plexus Injuries The nerves of the brachial plexus can be injured during a difficult delivery from: The infant's head and neck pulling toward the side as the shoulders pass through the birth canal Pulling on the infant's shoulders during a head-first delivery Pressure on the baby's raised arms during a breech (feet-first) delivery

23. Types of Brachial Plexus Injuries • Erb's Palsy • Klumpke's Palsy • Complete Palsy

24. Types of Brachial Plexus Injuries Erb's Palsy C5, C6 and sometimes C7 nerves are involved Often presents with arm straight and wrist fully bent (waiter's tip) May have good hand function but not full movement of the arm May have instability of the shoulder joint Often presents with weak biceps and deltoid muscles (unable to bend elbow or lift arm at the shoulder) Includes about 75 percent of all brachial plexus injuries

25. Complete Damaged to Brachial Plexus When all five nerves in the brachial plexus are injured it is called Complete Brachial Plexus palsy. The child loses the ability to face forward for any length of time (called torticollis) and is sometimes also afflicted with an eyelid droop on the same side of the affected hand/arm and constriction of the pupil (Horner’s Syndrome).  When paralysis occurs in both the arm and hand, it is called Klumpke’s palsy.

26. Klumpke's Palsy (1% of cases) - involves C8-T1;  newborn will be unable  to grasp or flex wrist. If sympathetic fibers of T1 are involved, there may be an ipsilateral ptosis and miosis (Horner's syndrome). This pattern of injury is much less common than Erb's. Prognosis is also poorer than Erb’s.

27. Symptoms Symptoms can be seen immediately or soon after birth, and may include: Newborn is not moving the upper or lower arm or hand Absent Moro reflex on the affected side Arm flexed (bent) at elbow and held against body Decreased grip on the affected side

28. Moro Reflex The Moro reflex is a normal reflex for an infant when he or she is startled or feels like they are falling. The infant will have a "startled" look and the arms will fling out sideways with the palms up and the thumbs flexed. Absence of the Moro reflex in newborn infants is abnormal and may indicate an injury or disease.

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