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  • Brachial plexus lesions
  • Injury to brachial plexus

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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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  • G54.0 Brachial plexus disorders
  • P14.0 Erb's paralysis due to birth injury
  • P14.1 Klumpke's paralysis due to birth injury
  • P14.3 Other brachial plexus birth injuries
  • S14.3XXA Injury of brachial plexus, initial encounter

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Description

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  • Weakness in the arm
  • Diminished reflexes
  • Pain in the upper extremity
  • 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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  • Electromyography
  • 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 classification
  • Neurapraxia (Class 1): 1st degree
  • Axonotmesis (Class 2): 2nd degree
  • Neurotmesis (Class 3): 3rd degree nerve fiber interruption, 4th degree epineurium intact, and 5th 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 common cause
  • Traction injury
  • Individuals who work for sustained periods with power tools or on computers
  • Infants, from birth trauma or head traction

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Signs and Symptoms

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  • Acute or chronic paresthesia
  • Sensory changes: hyposensitivity of hand
  • Hand clumsiness
  • Feeling of arm heaviness
  • Hand weakness; decreased grip-power and dexterity
  • Intrinsic muscle atrophy
  • Erb’s palsy
    • Waiter’s tip sign
    • Caused by excessive lateral neck flexion
    • Loss of lateral rotator, arm flexors, and wrist extensor musculature
  • Klumpike’s 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’s sign
  • Froment’s sign for ulnar nerve palsy
  • Bishop’s deformity
  • Positive elbow flexion test

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Functional Implications

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  • Night pain
  • Poor sleep habits with arm over head
  • Feeling of arm going “dead”
  • Limited hand function during ADLs/IADLs due to hand clumsiness and possible loss of strength

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Possible Contributing Causes

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  • Infant head traction during forceps delivery
  • Traction to the cervical spine
  • Trauma pulling the arm into abduction
  • Viral infection
  • Ganglion or space-occupying lesion
  • Repetitive trauma
  • Sustained pressure over the thoracic outlet
  • Clavicle fracture
  • Glenohumeral dislocation

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Differential Diagnosis

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