Diagnostic Issues
Supraclavicular
- nerve root patterns of sensation and motor disturbance
Infraclavicular
- peripheral nerve root pattern / cord
Supraclavicular preganglionic
- dorsal scapular / long thoracic / suprascapular nerves injured
- 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 / Pecs
Wrist drop
Side
Hand on head
- axillary scars
Back
Trapezius
Deltoid
Supraspinatus/ Infraspinatus
Static winging
Feel
Palpate post triangle
- tenderness
- supraclavicular post ganglionic
Tinel's in post triangle
- supraclavicular post ganglionic
Sensation
Ask patient about sensory loss
Supraclavicular C4
- suggests preganglionic injury
Axillary nerve C5
LCNF C6 musculocutaneous
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
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
Post Cord
- axillary nerve (deltoid + T minor)
- radial nerve
- subscapularis
- lat dorsi TDN C7 (hand on hip or cough)
Medial Cord
- medial median (FDP, FPL, AbPB)
- medial pectoral (sternal head)
- ulna nerve (interossei, LOAF)
- MCNA / MCNFA (decreased sensation medially)
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