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 deltoid. 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 hand. 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 accident cannot extend the metacarpophalangeal joints
Fractures of the shaft of humerus or after prolonged tourniquet
pressure 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 wrist 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 fingers) 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