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By: Nur Aqilah bt Zulkifli

Originates from the posterior cord of the brachial plexus

Innervates the deltoid and teres minor muscles. In addition, it has cutaneous branch, the superior
lateral cutaneous nerve of the arm, which carries sensation from the skin over the inferior part of the
The landmark for anterior branch (supplies the anterior two-third of the deltoid) is 5cm below the
tip of the acromion
 Takes place in a brachial plexus injury where the nerve can be
ruptured. Or often to be injured during shoulder dislocation or
fractures of the humeral neck.
 Patient may be complain of having shoulder weakness with the
finding of deltoid muscle wasting.
 Abduction can be initiated (by the action of supraspinatus) but it
cant be maintained.
 Numbness felt over the deltoid (Sergeant’s patch)
 Nerve injury with fracture or dislocation may heals
spontaneously in 80% cases
deltoid muscle shows no sign of recover by 8
 If
weeks, EMG (electromyography) should be
perform. If the test suggest denervation, then the nerve should
be explored through a combined deltopectoral and posterior
approach (quadrilateral space) – detection of injury as well as
nerve repairing

 Excision of the nerve ends and grafting may be

necessary and good result can be achieved if the nerve is
explore in 3 months after the injury
 However, if the operation fails and the shoulder is painfully
unstable, with the trapezius and serratus anterior are
functioning, shoulder arthrodesis can provide both stability and
some degree of abduction.

Athrodesis is surgical immobilization of a

joint by fusion of the adjacent bones.
Mixed sensory and motor nerve of the arm, forming the largest
branch of the brachial plexus.
It extends downwards
behind the humerus,
supplying muscle of
the upper arm, to the
elbow, which it supplies
with branches, and
then run parallel with
the radius.
It supplies sensory
branches to the base of
the thumb and a small
area of the back of the
 Maybe injured at the elbow, in the upper arm or in the axilla
(Low lesion)
 fractures or dislocations at the elbow, open wound or surgical
 cannot extend the metacarpophalangeal joints

 Fractures of the shaft of humerus or after prolonged tourniquet

 Fall asleep with the arm dangling over the back of a chair (Saturday
night palsy)
 Obvious wrist drop due to weakness of the wrist extensor
 Also loss of sensory on the back of the hand at the base of the thumb
Originates in the neck, from spinal roots of the cervical and
first thoracic division, and runs down the inner side of the
upper arm to behind the elbow
Passes through the arm and
forearm into hand where it
innervates all the intrinsic muscles
of the hand (except three thenar
muscle and two lateral lumbricals)
 Injuries usually near the wrist or near the elbow (medial side)
(Low Lesion)
 Caused by pressure (eg; from deep ganglion) or a laceration at the
 Hypothenar wasting
 Clawed hand (little finger and ring) due to paralysis of intrinsic muscles
 Finger abduction is weak
 Loss of thumb adduction; pinch difficult (Forement’s test)
 Loss of sensation over one and half fingers from medially
Froment’s sign
High Lesion
 Elbow fractures
 If malunion produces marked cubitus valgus with tension on the
nerve (Cubital Tunnel Syndrome)
Formed by union of lateral and medial roots originating from
the lateral and medial cord of the brachial plexus
Three thenar muscle associated
with the thumb
Two lateral lumbrical muscles
(movement of index and middle
Over the palmar, lateral three and
one half digits and over the lateral
side of the palm and wrist
Low lesion
o Caused by cuts in front of the wrist or by carpal dislocation
o Thenar eminence is wasted
o Thumb abduction and opposition are weak
o Loss of sensation over the radial three and a half digits
o Trophic changes may seen
High Lesion
 Generally due to forearm fracture or elbow dislocation
 Long flexors to the thumb, index and middle fingers are paralysed
 Other signs are same with those low lesions
Originates from the sciatic nerve in the posterior compartment of the
thigh and follows the medial margin of the biceps femoris tendon over
the lateral head of the gastrocnemius muscle and toward the fibula
 May damaged in lateral ligament injuries when the knee is
forced into varus
 Or by pressure from a splint or a plaster cast or by lying leg
externally rotated
 Drop foot in which dorsiflexion and eversion are weak

 High tendency to trip and fall while walking

 Loss of sensation over the front and outer half of the leg and
the dorsum of the foot

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