NAME: Taylor, Kimberly M.

SECTION: BSMLS - HERRICK

SUBJECT: EC 1 DATE: October 31, 2020

Case Study
T. D.’s Brachial Plexus Injury

Chief complaint:
T.D., a 16-year-old high school student, had a severe lacrosse accident that resulted in a flail
arm. He had sustained right brachial plexus injury and had no recovery. He has continued to
take medication for neurologic pain. He was scheduled to see his orthopedic surgeon for a
possible brachial plexus exploration.

Examination:
The orthopedic surgeon examined T.D. and noted that there had not been any change in his
condition since the previous visit. T.D. still had no feeling or motion in his right shoulder or arm.
He had atrophy over the supraspinatus and infraspinatus muscles and also subluxation of his
shoulder and deltoid atrophy. He had no active motion of the right upper extremity and no
sensation. The rest of his orthopedic exam showed full ROM of his hips, knees, and ankles with
intact sensation and palpable distal pulses as well as normal motor function. He was diagnosed
with a possible middle trunk brachial plexus injury from C7.

Clinical course:
T.D. and his parents had previous discussions with the surgeon and were aware of the prognosis
and treatment plan. With middle trunk brachial plexus injury, damage to the subscapular nerve
will interrupt conduction to the subscapularis and teres major muscles. Damage to the long
thoracic nerve prevents conduction to the serratus anterior muscles. Injury to the pectoral
nerves affects the pectoralis major and minor muscles.

T.D. was scheduled for an EMG, nerve conduction studies, and somatosensory evoked
potentials (SSEPs). His diaphragm was examined under fluoroscopy to R/O phrenic nerve injury.
The results of the diagnostic studies indicated that T.D. had most likely sustained a middle trunk
brachial plexus injury.

T.D. was scheduled for a brachial plexus exploration with possible nerve graft, nerve transfer,
bilateral sural (calf) nerve harvest, or gracilis muscle graft from his right thigh.

T.D.’s Follow-Up
The exploratory surgery confirmed the brachial plexus injury, and T.D. underwent the nerve
graft with muscle taken from his right thigh. After six days, he was discharged home with his
right arm in a shoulder immobilizer. He received instructions on activities and was told to see
the surgeon in one week and again three weeks later. Physical therapy was ordered to prevent
further atrophy and to begin rebuilding the arm muscles.

T.D. was frustrated with the slow progress, but the orthopedic surgeon had said that in time, he
should regain full use of his right arm and normal activities of daily living should be restored.
SUPERFICIAL MUSCLES, ANTERIOR VIEW

Write the name of each numbered part on the corresponding line of the answer sheet

Adductors of thigh Orbicularis oculi

Biceps brachii Orbicularis oris
Brachialis Pectoralis major
Brachioradialis Quadriceps femoris
Deltoid Rectus abdominis
Extensor carpi Sartorius
External oblique Serratus anterior
Fibularis longus Soleus
Flexor carpi Sternocleidomastoid
Gastrocnemius Temporalis
Intercostals Tibialis anterior
Internal oblique Trapezius
Masseter

1. Temporalis
2. Orbicularis oculi
3. Orbicularis oris
4. Masseter
5. Sternocleidomastoid
6. Trapezius
7. Deltoid
8. Pectoralis major
9. Serratus anterior
10. Brachialis
11. Biceps brachii
12. Brachioradialis
13. Flexor carpi
14. Extensor carpi
15. External oblique
16. Internal oblique
17. Rectus abdominis
18. Intercostals
19. Sartorius
20. Adductors of thigh
21. Quadriceps femoris
22. Gastrocnemius
23. Soleus
24. Fibularis longus
25. Tibialis anterior
SUPERFICIAL MUSCLES, ANTERIOR VIEW

Write the name of each numbered part on the corresponding line of the answer sheet

Deltoid Latissimus dorsi

Fibularis longus Sternocleidomastoid
Gastrocnemius Teres major
Gluteus maximus Teres minor
Gluteus medius Trapezius
Hamstring group Triceps brachii

1. Sternocleidomastoid
2. Trapezius
3. Deltoid
4. Teres minor
5. Teres major
6. Latissimus dorsi
7. Triceps brachii
8. Gluteus medius
9. Gluteus maximus
10. Hamstring group
11. Gastrocnemius
12. Fibularis longus
Terminology
MATCHING
Match the following terms and write the appropriate letter to the left of each number:

C 1. masseter a. main muscle of the calf

E 2. quadriceps femoris b. muscle of the upper back and neck
D 3. pectoralis major c. muscle used in chewing; jaw muscle
A 4. gastrocnemius d. large muscle of the upper chest
B 5. trapezius e. a group of four muscles in the thigh

E 6. dystonia a. instrument for measuring muscle work

A 7. ergometer b. slowness of movement
D 8. inotropic c. a small bundle of fibers
B 9. bradykinesia d. acting on muscle fibers
C 10. fascicle e. abnormal muscle tone

Supplementary Terms

D 11. glycogen a. substance that stores energy in muscle cells

E 12. tetany b. flat, white, sheet-like tendon
B 13. aponeurosis c. muscular spasms and cramps
A 14. creatine d. complex sugar stored in muscles
C 15. lactic acid e. a by-product of anaerobic muscle contractions

E 16. asterixis a. wryneck

B 17. ataxia b. lack of muscle coordination
A 18. torticollis c. awareness of movement
D 19. asthenia d. weakness
C 20. kinesthesia e. rapid, jerky movements, especially of the hands

C 21. clonus a. forcible tearing away of a part

E 22. athetosis b. acute infectious disease that affects muscles
D 23. spasm c. intermittent muscle contractions
B 24. tetanus d. sudden involuntary muscle contraction
A 25. avulsion e. condition marked by slow, twisting movements

Referring to T.D.’s case history

D 26. phrenic a. partial dislocation

E 27. atrophy b. shoulder muscle
A 28. subluxation c. network
C 29. plexus d. pertaining to the diaphragm
B 30. deltoid e. tissue wasting

FILL IN THE BLANKS

31. The neurotransmitter released at the neuromuscular junction is acetylcholine.
32. The sheath of connective tissue that covers a muscle is called fascia.
33. The number of origins (heads) in the triceps brachii muscle is three.
34. A muscle that produces extension at a joint is called a(n) extensor.
35. A band of connective tissue that attaches a muscle to a bone is a(n) tendon.
36. The strong, cord-like tendon that attaches the calf muscle to the heel is the achilles
tendon.
37. Movement away from the midline of the body is termed abduction.
38. A musculotropic substance acts on muscle tissue.
Referring to T.D.’s case study:

39. The nerves of the brachial plexus supply the sensory innervation to the upper limb
and most of the axilla.
40. The muscle above the spine of the scapula is the rhomboid major muscle.
41. The vertebra C7 is in the region of the neck.

DEFINITIONS
Define the following words:

42. myology (mī-OL-ō-jē) = The study of muscles

43. myofascial (mī-ō-FASH-ē-al)
44. tendinoplasty (TEN-din-ō-plas-tē)
45. inositis (in-ō-SĪ-tis)
46. hypotonia (hī-pō-TŌ-nē-a)
47. hyperkinesia (hī-per-ki-NĒ-sē-a)
= Pertaining about muscles and facia
= The plastic repair or tendons
= Inflammation in the fibers
= Decreased muscle tone
= abnormal increased movement

Write words for the following definitions:

48. inflammation of muscle (use my/o-) = Myositis

49. death of muscle tissue = Myonecrosis
50. suture of fascia = Fasciorrhaphy
51. absence of muscle tone = Atony
52. excision of fascia = Fasciectomy
53. study of movement = Kinesiology
54. surgical incision of a tendon (use ten/o-) = Tenotomy
55. pertaining to a tendon = Antagonist

OPPOSITES

Write a word that means the opposite of the following terms as they pertain to muscles:
56. agonist = Antagonistic
57. origin = Insertion
58. abduction = Adduction
59. pronation = Supination
60. extension = Flexion

ADJECTIVES

From the supplementary terms, write the adjective form of the following words:
61. ataxia = Ataxic
62. athetosis = Athetotic
63. spasm = Spasmic
64. clonus = Clonic

TRUE–FALSE

Examine the following statements. If the statement is true, write T in the first blank. If the statement is
false, write F in the first blank and correct the statement by replacing the underlined word in the second
blank.
True or False Correct Answer

65. The part of a neuron that contacts a muscle cell is the axon. TRUE
66. Skeletal muscle is voluntary. TRUE
67. The origin of a muscle is attached to a moving part. FALSE INSERTION
68. The hamstring group is in the anterior thigh. FALSE POSTERIOR
69. Pronation means turning downward. TRUE
70. Smooth muscle is also called visceral muscle. TRUE
71. The quadriceps muscle has three components FALSE 4
72. In an isotonic contraction, a muscle shortens. TRUE
ELIMINATIONS

In each of the sets below, underline the word that does not fit in with the rest and
explain the reason for your choice:

73. fascicle — fiber — tendon — osteoblast — fascia

- it related to the bones while the rest relates with muscles.
74. soleus — flexor carpi — biceps brachii — brachioradialis — extensor carpi
- soleus is a muscle calf while the rest are muscles in the arm.
75. vastus intermedius — intercostals — vastus lateralis — vastus medialis — rectus
femoris
- intercostals are in the ribs, while the rest are quadriceps muscles in the anterior
thigh
76. circumduction — inversion — actin — dorsiflexion — rotation
- actin is a filament, while the rest are types of movement.
77. EMG — ALS — FMS — CFS — MG
- electromyography, studies about electrical energy in muscles and diseases.

ABBREVIATIONS

Write the meaning of each of the following:

78. CTS = Carpal Tunnel Syndrome
79. ACh = Acetylcholine
80. RTC = Rotator Cuff
81. NMJ = Neuromuscular Junction
82. CK = Creatine Kinase

WORD BUILDING

Write a word for the following definitions using the word parts provided.

-ia ten/o -al alg/o -itis -desis -blast -lysis fasci/o my/o

83. an immature muscle cell = Myoblast

84. binding of a fascia = Fasciodesis
85. pain in a tendon = Tenalgia
86. destruction of muscle tissue = Myolysis
87. binding of a tendon = Tenodesis
88. inflammation of fascia = Fascitis
89. separation of a tendon = Tenolysis
90. pertaining to fascia = Fascial
91. pain in a muscle = Myalgia

WORD ANALYSIS
Define each of the following words, and give the meaning of the word parts in each. Use
a dictionary if necessary.

92. dermatomyositis (der-ma-tō-mī-ō-SĪ-tis)

= inflammation of the skin and underlying muscle tissue.
a. dermat/o = skin
b. my/o(s) = muscle
c. -itis = inflammation
93. myasthenia (mī-as-THĒ-nē-a)
= weakness in the muscles
a. my/o = muscles
b. A = lack of
c. sthen/o = strength
d. -ia = condition of

94. dyssynergia (dis-in-ER-jē-a)

= lack of smooth or accurate muscle movement
a. Dys = abnormal
b. Syn = together
c. erg/o = work
d. -ia = condition of

95. amyotrophic (a-mī-ō-TRŌ-fi k)

= pertaining to muscle wasting
a. A = lack of
b. my/o = muscles
c. troph/o = nourishment
d. -ic = pertaining to