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Brachial plexus lesion Classification and external resources
ICD-10	G54.0, P14.3, S14.3
ICD-9	353.0, 767.6, 953.4
DiseasesDB	31267
MeSH	D020516

Brachial plexus lesions are classified as either traumatic or obstetric.

Contents 1 Causes 2 Signs 3 Presentation 4 Diagnosis 5 See also 6 External Links

Causes

The brachial plexus lesion can be divided into 1) Upper brachial plexus lesionwhich occurs from excessive lateral neck flexion away from shoulder this in turn may lead to a deformity called a waiters tip deformity also called as Erb's palsy. 2) A lower brachial plexus lesion which results from hyperabduction of the arm leading to a claw hand deformity or Klumpke's palsy. These typically result from excessive stretching and avulsion injury. Traumatic injuries are often caused by high-velocity motor vehicle accidents, especially in motorcyclists. Injury from a direct blow to the lateral side of the scapula is also possible.

Most commonly, forceps delivery or falling on the neck at an angle causes upper plexus lesions leading to Erb's Palsy. This type of injury produces a very characteristic sign called Waiter's tip deformity due to loss of the lateral rotators of the shoulder, arm flexors, and hand extensor muscles.

Much less frequently, sudden upward pulling on an abducted arm (as when someone breaks a fall by grasping a tree branch) produces a lower plexus injury. This results in the sign known as clawed hand due to loss of function of the ulnar nerve and the intrinsic muscles of the hand it supplies.

Signs

The cardinal signs of brachial plexus avulsion are:

• weakness in the arm,
• diminished reflexes, and
• corresponding sensory deficits.

Presentation

In most cases the nerve roots are stretched or torn from their origin, since the meningeal coverings of the nerve roots are thinner than the sheaths enclosing the peripheral nerves. The epineurium of the peripheral nerve is contiguous with the dural mater, providing extra support to the peripheral nerves. In cases where the nerve roots have been torn, recovery is unlikely without invasive experimental surgical techniques.^{citation needed}.

Diagnosis

The diagnosis may be confirmed by an EMG examination in 5 to 7 days. The evidence of denervation will be evident. If there is no nerve conduction 72 hours after the injury, then avulsion is most likely.

See also

• Brachial plexus

External Links

• Blog about Brachial Plexus Injury

v • d • e Nervous system pathology, PNS (G50-G99, 350-359) Somatic Nerve, nerve root, plexus Cranial nerve disease V (Trigeminal neuralgia) · VII (Facial nerve paralysis, Bell's palsy, Melkersson-Rosenthal syndrome, Central seven) · XI (Accessory nerve disorder) Radiculopathy, plexopathy Brachial plexus lesion · Thoracic outlet syndrome · Phantom limb Mono- neuropathy upper limb (Carpal tunnel syndrome, Ulnar nerve entrapment, Radial neuropathy)  • lower limb (Meralgia paraesthetica, Tarsal tunnel syndrome, Morton's neuroma)  • Causalgia · Mononeuritis multiplex Polyneuropathies HMSN Charcot-Marie-Tooth disease · Dejerine Sottas syndrome · Refsum's disease Polyradiculoneuropathy autoimmune (Guillain-Barré syndrome, Chronic inflammatory demyelinating polyneuropathy) · Alcoholic polyneuropathy Muscular (myopathy), neuromuscular Neuromuscular- junction disease autoimmune (Myasthenia gravis, Lambert-Eaton myasthenic syndrome) Muscular dystrophy Congenital · dystrophin (Becker's, Duchenne) · Distal · Emery-Dreifuss · Facioscapulohumeral · Limb-girdle muscular dystrophy · Myotonic · Oculopharyngeal Myotonia Myotonic dystrophy · Myotonia congenita · Thomsen disease · Neuromyotonia · Paramyotonia congenita Congenital myopathy Bethlem myopathy · Central core disease · Centronuclear myopathy · Nemaline myopathy · Zaspopathy Mitochondrial myopathy MELAS · MERRF · KSS · PEO Periodic paralysis Hypokalemic · Hyperkalemic Dysautonomia, autonomic- neuropathy HSAN (I, II, Familial dysautonomia, Congenital insensitivity to pain with anhidrosis, V) · Horner's syndrome · Multiple system atrophy

v • d • e Certain conditions originating in the perinatal period / fetal disease (P, 760-779) Maternal factors and complications Umbilical cord prolapse - Nuchal cord - Chorioamnionitis Length of gestation and fetal growth Small for gestational age - Large for gestational age - Premature birth - Postmature birth Birth trauma Cephalhematoma - Brachial plexus lesion (Erb's palsy, Klumpke paralysis) Respiratory Intrauterine hypoxia - Infant respiratory distress syndrome - Transient tachypnea of the newborn - Meconium aspiration syndrome - pleural disease (Pneumothorax, Pneumomediastinum) - Wilson-Mikity syndrome - Bronchopulmonary dysplasia Cardiovascular Pneumopericardium - Persistent fetal circulation Haemorrhagic and haematological/ hematologic disease Haemorrhagic disease of the newborn - Hemolytic disease of the newborn - Rh disease - Hydrops fetalis - Hyperbilirubinemia (Kernicterus, Neonatal jaundice) Digestive system Ileus - Necrotizing enterocolitis Integument and temperature regulation Erythema toxicum Other disorders Periventricular leukomalacia - Gray baby syndrome - muscle tone (Congenital hypertonia, Congenital hypotonia) - Perinatal infection (Congenital rubella syndrome) - Velamentous cord insertion - Omphalitis

v • d • e Injuries, other than fractures, dislocations, sprains and strains (S00-T14, 850-929) Head (head injury) and neck Traumatic brain injury (Concussion, Diffuse axonal injury, Cerebral contusion, Epidural hematoma, Subdural hematoma, Subarachnoid hemorrhage) Facial trauma (Black eye  · Eye injury) Thorax (chest trauma) lung: pleural disease (Pneumothorax, Hemothorax, Hemopneumothorax)  · Pulmonary contusion  · Pulmonary laceration heart and circulatory: Cardiac tamponade  · Commotio cordis  · Hemopericardium  · Traumatic aortic rupture Abdomen, lower back, lumbar spine and pelvis Ruptured spleen  · Traumatic diaphragmatic hernia Shoulder and upper arm Rotator cuff tear General Spinal cord injury  · Brachial plexus lesion Abrasion  · Amputation  · Avulsion  · Bite  · Blister  · Bruise  · Burn  · Hematoma Wound

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