Brachial plexus lesion
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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 traumatic or obstetric.
Contents |
Causes
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:
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 5-7 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
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Certain conditions originating in the perinatal period (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 and cardiovascular | Intrauterine hypoxia - Infant respiratory distress syndrome - Transient tachypnea of the newborn - Meconium aspiration syndrome - Pneumomediastinum - Wilson-Mikity syndrome - Bronchopulmonary dysplasia |
| Haemorrhagic and haematological | Hemorrhagic disease of newborn - Hemolytic disease of the newborn - Rh disease - Hydrops fetalis - Kernicterus - Neonatal jaundice |
| Digestive system | Ileus - Necrotizing enterocolitis |
| Integument and temperature regulation | Erythema toxicum |
| Other disorders | Periventricular leukomalacia - Congenital hypertonia - Congenital hypotonia - Congenital rubella syndrome |
Injuries, other than fractures, dislocations, sprains and strains (S00-T14, 850-929) | |
|---|---|
| Head (head injury) and neck | Black eye - Traumatic brain injury (Concussion, Diffuse axonal injury, Cerebral contusion, Epidural hematoma, Subdural hematoma, Subarachnoid hemorrhage) |
| Thorax (chest trauma) | Traumatic aortic rupture - Pneumothorax - Hemothorax - Hemopneumothorax - Pulmonary contusion - Cardiac tamponade - Commotio cordis |
| Abdomen, lower back, lumbar spine and pelvis | Ruptured spleen |
| Shoulder and upper arm | Rotator cuff tear |
| General | Spinal cord injury - Brachial plexus lesion
Abrasion - Blister - Bruise - Hematoma Wound - Bite |
