branches from roots
- long thoracic
- dorsal scapular
long thoracic
- c5-c7
- passes vertically down neck + medial wall axilla
- lies superficially to serratus anterior
- innervates serratus anterior
dorsal scapular
- c5
- passes posteriorly + pierces middle scalene
- travels along medial border of scapula
- rhomboids, levator scapulae
injury to long thoracic
- Susceptible to injury through direct trauma or stretch
- Blow to the ribs underneath an outstretched arm - Damaged during surgery for breast cancer
- Stab injuries
- Carrying heavy bags over the shoulder for a prolonged time
Symptoms
- A posterior shoulder or scapular burning type of pain may be reported
- A lesion of the nerve paralyses serratus anterior - Winged scapula
- Patient pushes an outstretched arm against a wall
C5,C6,C7 - RAISE YOUR WINGS UP TO HEAVEN - WINGED SCAPULA - LONG THORACIC NERVE ROOTS INNERVATE SERRATUS ANTERIOR
branches from trunks
superior trunk only
nerve to subclavius
- passes anteroinferiorly to subclavian artery + vein
suprascapular
- passes laterally through posterior triangle of neck - through trapezius to spinous fossa - through suprascapular notch
- supraspinatus + infraspinatus
suprascapular nerve injury
due to entrapment neuropathy in suprascapular notch:
- shoulder pain
- weakness/ wasting of infra/supraspinatus
injuries
stretch/Neuropraxia/Praxis Injury
- nerves damaged but not torn - - Swelling/bruising/compression/over-stretching
- Most common type of injury
- 90 –100% return of function
Neuroma
- Scar tissue around injury prevents communication with muscle, thus impairing movement
May requires surgery for removal of scar tissue
Rupture
Nerves torn in 1 or more places, but not detached
Surgery may repair, damage usually permanent
Avulsion
Most serious brachial plexus injury
Nerve torn
Permanently damaging consequenc
obstetrical brachial plexus injuries
Most brachial plexus injuries occur at birth
2-5/1000 births
Shoulder dystocia - Fetal head is delivered, but shoulders are trapped behind mothers pelvic bone
In many cases child will recover full function in 1st week of life
If no improvement in 1st 2 weeks, recovery not likely
Permanent impairment occurs in up to 25% of cases
upper plexus palsy
Erb-duchenne palsy - waiter’s tip
tearing of roots c5 + c6
lower plexus palsy
klumpke paralysis
tearing of T1 root
