Friday, December 13, 2013

Brachial Plexus Lesions

  1. Humeral Fracture and Brachial Plexus Lesions:
    • Surgical neck -> Axillary nerve
    • Medial epycondile -> Ulnar nerve
    • Supracondylar -> Median nerve
    • Mid-shaft -> Radial nerve.


  1. Q: A 34-year-old man who is a construction worker is brought to the emergency department after a recent fall at workk. He says that he landed on his elbow and recently has had some weakness in his hand. Physical examination shows ecchymosis, swelling, and pain at the distal humerus and elbow. An initial neurologic examination shows weakness with thumb adduction and sensory loss on the medial palm. There are no abnormalities with thumb abduction and flexion. Notably, there is clawing of the fourth and fifth digits. This patients most likely has an injury to a nerve that arises from which part of the brachial plexus?

    A: Medial cord

  2. Q: A 30-year-old woman is brought to ER 30 minutes after being involved in a motor vehicle collision. She reports that she was hit from behind and thrust forward, slamming her left arm into the steering wheel. Physical examination shows a grossly displaced humeral fracture with significant bruising in the surrounding region. The injury is surgically reduced and the patient's arm is placed in a cast. Three months after the incident, the patients complains of weakness in her left arm. Physical examination shows that she is unable to extend the left arm, and has decreased sensation on the posterior aspect of the left forearm and hand. Which of the fkind of muscles has most likely atrophied in this patient and what nerve was injured?

    A: Supinator - Radial nerve lesion

  3. Q: A 50-year-old man who is an electrician comes to the physician because of recent onset pain and tingling in his left arm. He reports that his job entails a great deal of overhead electrical work and that raising his arms above his head makes the symptoms worse. Neurologic examination shows absence of sensation to light touch and pinprick on the fourth and fifth digits of his left hand and his medial forearm. There is also clawing of all digits of the left hand. Rotating the patient's head to the left side with the neck extended results in loss of the radial pulse on the left. An x-ray of the neck shows a cervical rib. Which artery and which part of the brachial plexus is most likely being compressed?

    A: Subclavian artery and the Lower trunk of brachial plexus

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