Anatomy of the Brachial Plexus

Mechanisms of Brachial Plexus Injury and Pathologies

Neurological Evaluation for the Brachial Plexus and Related Special Tests

 Roots  Trunks  Real



 Divisions
 Cords  Branches

 Drink
 Cold  Beer

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



Brachial Plexus Branches & Muscular Innervations Dorsal Scapular N.   Levator Scapulae Rhomboid Major/Minor Infraspinatus Supraspinatus Musculocutaneous N.   Suprascapular N.     Biceps Brachii Brachialis Coracobrachialis Pectoralis Major/Minor . Lateral Pectoral N.

 Lower Subscapular N.   Deltoid Teres Minor Middle Subscapular or Thoracodorsal N.Brachial Plexus Branches & Muscular Innervations Axillary N.  Latissimus Dorsi Upper Subscapular N.   Subscapularis Subscapularis Teres Major .

 Abductor Pollicis Brevis/Longus Abductor Pollicis Brevis    Flexor Carpi Radialis Flexor Digitorum Superficialis Flexor Digitorum Profundus (Lat.) & Longus Lumbricales (Lat. 2) Flexor Pollicis Brevis (Lat.Median N. 2) Opponens Pollicis Palmaris Longus Pronator Quadratus Pronator Teres *    Anconeus Brachioradialis Extensor Carpi Radialis Brevis/Longus Extensor Carpi Ulnaris Extensor Digiti Minimi Extensor Digitorum Communis              Extensor Indicis Extensor Pollicis Brevis/Longus Supinator Triceps Brachii .  Brachial Plexus Branches & Muscular Innervations Radial N.

2) Opponens Digiti Minimi Palmar Interossei Medial Antebrachial Cutaneous N. 2) Flexor Pollicis Brevis (Med.  Pectoralis Major Medial Brachial Cutaneous N.  Abductor Digiti Minimi Adductor Pollicis Dorsal Interossei Flexor Carpi Ulnaris Flexor Digiti Minimi Flexor Digitorum Profundus (Med. (sensory)    Lumbricals (Med.        Long Thoracic N.) Serratus Anterior Medial Pectoral N.Brachial Plexus Branches & Muscular Innervations Ulnar N. (sensory) .

Mechanisms of Injury to the Brachial Plexus .

fencing. 2000)    . and gymnastics Nerve injuries can result from blunt force trauma. or chronic repetitive stress Patients generally present with pain and/or muscle weakness Over time. wrestling. poor posture. baseball. basketball. Brachial Plexus Injury Overview Sports most commonly associated with brachial plexus injuries include: football. some patients may experience muscle atrophy (Duralde. volleyball.

resolution time. 1998) . rule out fractures and dislocations Brachial plexus injuries resolve quicker than spinal cord injuries (Prentice. et al. 2003)  Evaluate athletes immediately after injury and again after the game/practice (Kuhlman & McKeag.846)   Evaluation for return-to-play should take into consideration symptoms. Brachial Plexus Injury Overview Before performing special tests. and prior injuries to this region (Gorden. p..

Three Mechanisms of Injury  Percussion  Traction Cervical Nerve Compression  .

Percussion Occurs with direct blow to the supraclavicular fossa over Erb’s point (Troub. 2001) Example: Cross-check to a hockey player .

2001) Example: Gymnast falls on beam .Traction Occurs with a direct blow to the shoulder with the neck laterally flexed toward the unaffected shoulder (Troub.

Cervical Nerve Compression Occurs when the neck is flexed laterally toward the patient’s affected shoulder Caused by compression or irritation of the nerves. 2001) Example: Football player tackles an opponent . resulting in point tenderness over involved vertebrae of affected nerve(s) (Troub.

Traction B. Percussion C. Cervical Nerve Compression .A.

Three Grades of Injury  Grade 1 – Neuropraxia  Grade 2 – Axonotmesis  Grade 3 – Neurotmesis .

 Results in a disruption in the function of a nerve that produces numbness and tingling Grade 1 .2000) .Neuropraxia  Most common grade within athletics  Symptoms usually resolve within several minutes (Duralde.

2000) . tingling. and affected function (may last several days)   Long nerves have a greater healing time than short nerves  Rare within athletics (Duralde. Grade 2 Axonotmesis Damage to the nerve’s axon Symptoms include numbness.

2000) .Grade 3 . and penetrating injuries” (Duralde. fractures.Neurotmesis  Permanent nerve damage occurs  Very rare within athletics  “Occurs with high-energy trauma.

and 2nd digit . 1st digit.C5-C6 Affected  Motor Deficits: Shoulder abduction. elbow flexion. and wrist extension  Sensory Loss: Lateral arm. shoulder flexion.

C7 Affected  Motor Deficits: Elbow extension weakness and wrist flexion  Sensory Loss: Pad of index finger .

and medial arm . 5th digit. medial forearm.C8-T1 Affected (very rare)  Motor Deficits: Finger abduction/adduction and thumb flexors/extensors  Sensory Loss: 4th digit.

C5-T1 Affected  Motor Deficits: Scapular motion and entire arm  Sensory Loss: Entire arm. forearm. and hand .

Process of Evaluation .

thumb. Dermatomes C5 – Lateral arm C6 – Lateral forearm. index finger   C7 – Posterior forearm. ring and little finger  T1 – Medial arm . middle finger  C8 – Medial forearm.

spread fingers and resist finger adduction . C5 – Shoulder abduction Myotomes  C6 – Elbow flexion or wrist extension  C7 – Elbow extension or wrist flexion  C8 – Grip strength. shake hands  T1 – Interossei.

• Sensory – Anterior arm • Motor – Elbow flexion .Peripheral Nerve Tests Axillary N. • Sensory – Lateral arm • Motor – Shoulder abduction Musculocutaneous N.

• • Sensory – Pad of Index finger Motor – Thumb pinch and abduction Motor – Wrist extension and thumb extension Ulnar N. • • Sensory – space 1st Dorsal web Median N.Peripheral Nerve Tests Radial N. • • Sensory – Pad of little finger Motor – Finger abduction .

The “burner”: A common nerve injury in contact sports. 209-218. D. Inc. References . C. 2006 from the Northwest Texas Sports Medicine Clinic website. Philadelphia. B.. Davis Company. 38(3). H.. A. M. (2003). J. & McKeag. Straub. Northwest Texas Sports Medicine Clinic. (1999). (2001). K. pp. American Family Physician. & Ryan. Hoppenfeld.. Journal of Athletic Training. pp. B. 2006 from the American Academy of Family Physicians database. B. C. NJ: Pearson Education. J. Kuhlman. Timmons. 60(7). Gorden. (2000). pp. X.93-127. A. (2002). Brachial plexus injuries in athletics: “Burners”. Neurologic injuries in athlete’s shoulder. Journal of Athletic Training. J. Human Anatomy. PA: F. (1976).. Martini. & Swanik. S. M. J. F. A. S. & Tallitsch.. Swanik. R.316-318. Troub. (2003). Retrieved April 5. Retrieved March 5. 35(3). G. Upper Saddle River. S. Evaluation of Orthopedic and Athletic Injuries. Starkey. A. Physical Examination of the Spine & Extremities. Effects of football collars on cervical hyperextension and lateral flexion. Upper Saddle River: NJ: Prentice Hall.Duralde.