Brachial Plexus Injury (BPI)
Neuromuscular Orthopedics: Clinical Presentation & Patterns
1. Classic Injury Patterns
| Injury Type | Involved Roots | Clinical Presentation |
|---|---|---|
| Erb’s Palsy | C5, C6 (Upper Trunk) | “Waiter’s Tip” deformity: Arm adducted/internally rotated, forearm pronated. |
| Klumpke’s Palsy | C8, T1 (Lower Trunk) | “Claw Hand”: Intrinsic muscle paralysis; often involves Horner’s syndrome. |
2. High-Yield NEET Pearls
- Erb’s Palsy Cause: Commonly due to shoulder dystocia during birth (traction on the neck).
- Klumpke’s Palsy Cause: Hyperabduction of the arm (e.g., catching a tree branch while falling).
- Horner’s Syndrome: Seen in Klumpke’s palsy if the T1 root is avulsed proximal to the sympathetic chain (miosis, ptosis, anhidrosis).
- “Global” Palsy: Involves C5–T1 roots; presents as a flail, anesthetic arm. Requires intensive surgical reconstruction (nerve grafts/transfers).
- Diagnosis: MRI of the brachial plexus is the gold standard for identifying root avulsions (pseudomeningocele formation). EMG is useful for assessing severity after 3 weeks.