Brachial Plexus

Diagnostic Issues

 

Supraclavicular

- nerve root patterns of sensation and motor disturbance

 

Infraclavicular

- peripheral nerve root pattern / cord

 

Supraclavicular preganglionic

- dorsal scapular, long thoracic, suprascapular

- Horner's

- lack of sensation supraclavicular

- no tinel's

 

Supraclavicular postganglionic

- + Tinels

- tender posterior triangle

 

Look

 

Aids

 

Front

 

Horner's 

- suggests C8/T1 root avulsion

 

Posterior triangle swelling / bruising

 

Wasting deltoid / biceps / pectoralis

 

Biceps Wasting

 

Wrist drop

 

Side

 

Hand on head

- axillary scars

 

Back

 

Trapezius

Deltoid

Supraspinatus/ Infraspinatus

Static winging

 

Supraspinatous Infraspinatous Wasting

 

Feel

 

Palpate post triangle

- tenderness

- supraclavicular post ganglionic

 

Tinel's in post triangle

- supraclavicular post ganglionic

 

Sensation

 

Ask sensation

 

Supraclavicular C4 

- suggests preganglionic injury

 

Axillary nerve C5 

 

LCNF C6 musculocut n

 

SRN C6 (1st dorsal webspace) 

 

C6 median n (thumb)

 

C7 median n (MF)

 

C8 ulnar n (LF)

 

C8 MCNF m cord (med forearm)

 

T1 MCNA m cord

 

T2 ICBN

 

Motor

 

Trapezius 

- function of accessory nerve important

 

Roots / From Behind

 

Rhomboids

- shoulders back

- DSN C5

 

Rhomboid Testing

 

Serratus anterior

- push shoulder forward

- LTN C5-7

 

Suggest preganglionic

 

Trunk

 

Suprascapular Nerve (C5)

- supraspinatous

- infraspinatous

 

Front / Nerve Root innervation

 

Deltoid 

- C5

- axillary / posterior cord

 

Bicep

- C5

- musculocutaneous / lateral cord

 

Tricep

- C7

- radial / posterior cord

 

Wrist extension

- C6

- radial / posterior cord

 

Finger flexion

- C8

- median / medial and lateral cord

 

Finger abduction

- T1

- ulna nerve / medial cord

 

Decide if fits root pattern

- otherwise consider cord injury

 

Cords

 

Posterior Cord

- axillary nerve (deltoid + T minor)

- radial nerve

- subscapularis

- lat dorsi TDN C7 (hand on hip / cough)

 

Medial Cord

- medial median (FDP, FPL, AbPB)

- medial pectoral (sternal head)

- ulna nerve (interossei, LOAF)

- MCNA / MCNFA (decreased sensation medially)

 

Pectoralis Testing

 

Lateral Cord

- lateral median (FCR, PT)

- musculocutaneous (biceps, sensation lateral forearm)

- lateral pectoral (clavicular head)

 

Reflexes

 

Biceps C5

Triceps C7

BR C6

 

4Cs

 

Cephalad joint - Neck

Concealed - axilla

Circulation

Collagen