Professor Muhammad Rafique Brachial Plexus Injuries Professor Muhammad Rafique

Typical Spinal Nerve

Assisted Labor

Difficult Labor

Breech Presentation

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

Sing

Symptoms

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

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

Draw “arches”.

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

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

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

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

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

There are 4 supraclavicular branches. Roots Long Thoracic n. Dorsal Scapular n. Trunks Upper N. to subclavius Middle Lower Suprascapular n. Divisions Posterior Cords Lateral Upper subscapular Medial 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

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

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

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

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.

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

Types of Brachial Plexus Injuries Erb's Palsy Klumpke's Palsy Complete Palsy

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

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.

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.

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

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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