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Condition/Disorder Synonyms

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  • Brachial plexus lesions

  • Injury to brachial plexus

  • Stinger/burner syndrome

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ICD-9-CM Codes

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  • 353.0 Brachial plexus lesions

  • 767.6 Injury to brachial plexus due to birth trauma

  • 953.4 Injury to brachial plexus

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ICD-10-CM Codes

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  • G54.0 Brachial plexus disorders

  • P14.0 Erb paralysis due to birth injury

  • P14.1 Klumpke paralysis due to birth injury

  • P14.3 Other brachial plexus birth injuries

  • S14.3XXA Injury of brachial plexus, initial encounter

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Preferred Practice Patterns

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Key Features

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Description

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  • Weakness in the arm

  • Diminished reflexes

  • Pain in the upper extremity

  • Brachial plexus made up of the ventral rami of C5 to C8 and T1 nerve roots

  • Motor or sensory changes in the ulnar, radial, and median nerve distribution due to pressure from

    • - Compression

    • - Stretch

    • - Friction

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Essentials of Diagnosis

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  • Unilateral symptoms

  • Electromyography (EMG)

  • Pain

  • Numbness

  • Sensory changes in multiple peripheral nerves of the upper extremity

  • Hand clumsiness or weakness

  • Symptom changes with cervical spine and elbow positions

  • Reproduction of symptoms during clinical examination

  • Seddon's classification2

    • - Neurapraxia (class 1): First degree

    • - Axonotmesis (class 2): Second degree

    • - Neurotmesis (class 3): Third-degree nerve fiber interruption, fourth-degree epineurium intact, and fifth-degree complete transection of the nerve

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General Considerations

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  • Need to differentiate between more proximal and distal ulnar nerve compression, thoracic outlet syndrome (TOS), ulnar tunnel, and cervical radiculopathy.

  • Nerve compression syndrome in the upper extremity.

  • Wallerian degeneration occurs below the site of injury.

  • Patients with mild electrodiagnostic findings, intermittent symptoms, and no atrophy respond well to conservative management.

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Demographics

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  • Falling on an outstretched arm is a common cause.

  • Traction injury.

  • Individuals who work for sustained periods with power tools or on computers.

  • Infants, from birth trauma or head traction.

  • Forty-five to 65% of college players have reported a brachial plexus injury.3

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Clinical Findings

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Signs and Symptoms

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  • Motor or sensory changes to the peripheral nerves innervated off the brachial plexus4

  • Acute or chronic paresthesia

  • Burning sensation

  • Sensory changes: Hyposensitivity of hand

  • Hand clumsiness

  • Feeling of arm heaviness

  • Hand weakness; decreased grip power and dexterity

  • Intrinsic muscle atrophy

  • Erb palsy

    • - Waiter tip sign

    • - Caused by excessive lateral neck flexion

    • - Loss of lateral rotator, arm flexors, and wrist extensor musculature

  • Klumpke paralysis

    • - Traction of abducted arm

    • - Lower brachial plexus injury

    • - Damage to C8 and T1

    • - Loss of intrinsic muscles of the hand, wrist, and finger flexors

  • Wartenberg sign

  • Froment sign for ulnar nerve palsy

  • Bishop deformity

  • Positive ...

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