A 45 year-male presents with abrupt onset pain, weakness, loss of contour of shoulder and muscle wasting on 5th day of tetanus toxoid immunization. Likely cause is
BRACHIAL PLEXUS INJURIES It can be: Supraclavicular injury 65% Infraclavicular injury 25% Combined 10% It can also be: Upper plexus injury. Lower plexus injury. It can be: Pre-ganglionic injury Post-ganglionic injury Avulsion injury Usually less severe More dangerous Better recovery Extends into the spinal cord Upper plexus injury (Erb's Duchenne paralysis) Lower plexus injury (Klumpke's paralysis) It is due to depression of shoulder by trauma After diffucult labour in newborn. Here C5 and C6 roots are injured Muscles affected are deltoid, biceps, brachioradialis & supinator Effects Elbow will be extended, pronated & upper limb is internally rotated (Policemen receiving tip) Sensory deficit over the lateral aspect of arm & upper pa of the lateral forearm Forcible hyperabduction of shoulder causes thr injury In newborn it results due to difficult breech delivery Here C8 & 51 are injured Intrinsic muscles of hand are involved Effects Combines Median & Ulnar claw hand Horner's syndrome Sensory deficit over the medial aspect of forearm, hand & medial 1 1/2 finger Investigations Nerve conduction studies. CT/MRI. Electromyogram. X-ray cervical spine and pa. Treatment Conservative, nerve repair. Tendon transfer, physiotherapy. Osteotomy of coracoid process proximal to the attachment of pectoralis minor, sho head of biceps and coracobrachialis is done to improve abduction--Sever's operation. Ref: SRB's Manual of Surgery 5th edition Pgno : 265
Hysterical
Radial nerve entrapment
Brachial plexus neuritis
Thoracic outlet syndrome
Trauma