Brachial Plexus Injury Brachial Plexus Injury .pptx

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1. Brachial plexus injury dr. Cokorda Khrisna D P

2. Definition Injury of Brachial Plexus caused by various mechanisms. 1,2 Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Kim DH, Murovic JA, Kline DG. Brachial Plexus Injury : Mechanisms, Surgical Treatment and Outcomes. J Korean Neurosurg Soc 36 : 177-185, 2004.

3. Epidemiology In recent literature, the prevalence rate is about 1.2% after multiple traumatic injuries. 3 Annual incidence is about 1.64 cases out of 100,000 people. 3 Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11 .

4. anatomy Anatomy of Brachial Plexus. 1,2 Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Kim DH, Murovic JA, Kline DG. Brachial Plexus Injury : Mechanisms, Surgical Treatment and Outcomes. J Korean Neurosurg Soc 36 : 177-185, 2004.

5. etiology Traumatic. 1 Supraclavicular (50%) Infraclavicular (40%) Combined (10%) Non-Traumatic. 2 Tumor Irradiation Congenital Abnormalities (Cervical Ribs) Obstetrical Birth Injury, 2 Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Kim DH, Murovic JA, Kline DG. Brachial Plexus Injury : Mechanisms, Surgical Treatment and Outcomes. J Korean Neurosurg Soc 36 : 177-185, 2004.

6. Pathogenesis 1,3 Etiology of BPI Traumatic Non-Traumatic Obstetrical Birth Injury Traction Injury Compression Mechanism Supraclavicular Lesion Motorcycle injury: the patient collides with the ground or another vehicle  his neck and shoulder are wrenched apart. Infraclavicular Lesions Usually associated with fractures or dislocations of the shoulder Combined Acute Compression Gradual Compression Brachial Plexus Damage Usually traumatic. Obstetrical birth injury Location Degree Preganglionic. Post-Ganglionic. Neuropraxia. Axonotmesis. Neurotmesis. NEUROLOGICAL DEFICIT Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11

7. PathogenesiS Neurologic and functional loss of brachial plexus injury. 3 Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11 .

8. diagnosis History 2,3 Upper limb weakness. Pain History of trauma / other etiology. DEPENDS ON THE LEVEL AND LOCATION OF THE LESION. Physical Examination 1 DEPENDS ON THE LEVEL AND LOCATION OF THE LESION. Pre-Ganglionic / Root Avulsion. Crushing or burning pain in an anaesthetic hand. Paralysis of scapular muscles or diaphragm. Horner’s syndrome – ptosis, miosis (small pupil), enophthalmos and anhidrosis. Severe vascular injury. Associated fractures of the cervical spine. Spinal cord dysfunction (e.g. hyper- reflexia in the lower limbs). Post-Ganglionic Weakness, amenable to repair. Investigations 3 Radiologic Examination Plain X-Ray (to assess fractures, if presents). Myelography. CT-Myelography MRI Ultrasonography Electrophysiology Studies: Electromyography. Serial EPS Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Kim DH, Murovic JA, Kline DG. Brachial Plexus Injury : Mechanisms, Surgical Treatment and Outcomes. J Korean Neurosurg Soc 36 : 177-185, 2004. Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11

9. Diagnosis – BPI IN NEONATES (Classification) Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Erb’s Palsy. 1 Caused by injury of C5, C6 and (sometimes) C7. The abductors and external rotators of the shoulder and the supinators are paralysed . The arm is held to the side, internally rotated and pronated. There may also be loss of finger extension. Klumpke’s Palsy. 1 Due to injury of C8 and T1 The baby lies with the arm supinated and the elbow flexed. Loss of intrinsic muscle power in the hand. Reflexes are absent and there may be a unilateral Horner’s syndrome. Total Plexus Injury, 1 The baby’s arm is flail and pale. All finger muscles are paralysed and there may also be vasomotor impairment and a unilateral Horner’s syndrome. Narakas’s Classification for Obstetric Brachial Plexus Injury. 1 Group 1 C5/C6 Group 2 C5/C6/C7 Group 3 Entire plexus involved Group 4 Entire plexus with Horner’s sign

10. Diagnosis 1,3 Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11

11. Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11 treatment Treatment 1 Observation Nerve Grafting and Nerve Transfer Nerve grafting is often necessary and the results for restoration of shoulder and elbow function are quite good. Nerve transfer is an alternative way of providing functioning axons For Obstetric Brachial Plexus Injury. In next few weeks, paralysis may be: Recover completely. Improve Remain unaltered Later Reconstruction Tendon transfer. Free muscle transfer Shoulder arthrodesis Wrist arthrodesis Donor and Recipient Nerves 3

12. PROGNOSIS AND COMPLICATION 3 Most patients with BPI have obtained a recovery of useful arm motor function after surgical reconstruction. Operative repair technique was an important factor in brachial plexus reconstruction and recovering the use of an arm. Pain after BPI is usually neuropathic , with rates of neuropathic pain reported as high as 95%. Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11 .

13. rEFERENCES Fox M, Warwick D, Srinivasan H. Pheripheral Nerve Injuries. In: Blom A, Warwick D, Whitehouse MR, editors. Apley & Solomon’s System of Orthopaedics and Trauma. 10 th edition. 2018. New York: CRC Press. P 287-92. Kim DH, Murovic JA, Kline DG. Brachial Plexus Injury : Mechanisms, Surgical Treatment and Outcomes. J Korean Neurosurg Soc 36 : 177-185, 2004. Park HR, Lee GS, Kim IS, Chang JC. Brachial Plexus Injury in Adults. The Nerve.2017.3(1):1-11

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