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Branchial Plexus Injury

  1. Brachial plexus is formed by confluence of nerve roots from C5 to T1. It is vulnerable to injury — either a stab wound or severe traction caused by a fall on the side of neck or the shoulder.
  2. Traction injuries are generally classified as supraclavicular (65%), infraclavicular (25%) and combined (10%).
  3. Supraclavicular lesions typically occurs in motor cycle accident as the cyclist collides with the ground and his neck and shoulder are wrenched apart (may be associated with subclavian artery injury).
  4. Infraclavicular lesions are usually associated with fractures or dislocations of the shoulder. & axillary artery injury
  5. Avulsion of nerve root from spinal cord is a preganglionic lesion, i.e. disruption proximal to dorsal root ganglion; this can not recover and it is surgically irreparable, Rupture of a nerve root distal to ganglion, or of a trunk or peripheral nerve, is a post ganglionic lesion, which is surgically reperable and potentially capable of recovery.
Preganglionic Lesion Feature Postganglionic
Proximal to dorsal root ganglion i.e. avulsion of nerve root from spinal cord Site Distal to dorsal root ganglion i.e. disruption of nerve root (distal), trunk or peripheral nerve.
Can not recover Spontaneous recovery Potentially capable of recovery
Irreperable Surgical repair Reperable
Poor Prognosis Better
Positive Histamine Test i.e. triple response on intradermal injection Negative
  1. In upper plexus injuries (C5 & 6) the shoulder abductors and external rotators and forearm supinators are paralysed. Sensory loss involves the outer aspect of the arm and forearm. The arm is held to the side internally rotated and pronated. (Policeman tip deformity).
  2. Klumpke’s palsy (lower plexus injury) is much less common, but more severe. Wrist and finger flexors are weak and the intrinsic hand muscles are paralysed. Sensation is lost in ulnar forearm & hand, there may also be vasomotor impairment and unilateral Horner’s syndrome.
  3. The best results of plexus reconstruction are obtained after very early operation. All efforts of nerve repair or nerve transfer are directed towards lesions involving C5 & 6. The objectives are to regain shoulder abduction, elbow flexion,wrist extension, finger flexion, and sensibility over the hand.
  4. Erb’s palsy is the commonest brachial plexus injury causing neurological deficit in upper limb.

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