Brachial plexus examination:

SEQUENCE (MNEMONIC):
Robert Taylor Drinks Cold Beer = Rami, Trunks, Divisions, Cords & Branches

Inspection
1. The attitude of both upper limb is______
Upper brachial plexus injury Lower brachial plexus injury
Erb’s plasy Klumpke’s palsy
Shoulder – IR Claw hand
Elbow- Extend
Forearm – pronate
Wrist – flex

2. There is/no muscle wasting

3. In face, there is/no sign of horner syndrome by: interruption sympathetic trunk in
neck (lesion supraganglionic C8-T1)
a. Ptosis
b. Myosis
c. Anhidrosis
d. Enophthalmos

4. There is/no neck swelling or bruises or

deformity
Palpation
1. There is/no local rise in temperature
2. There is/no bony tenderness of clavicle, scapula and upper end of humerus(GT, LT)
3. There is/no tenderness joints

Movement+Neurological
From up to below
Motor

1. Standing from the back

Trapezius (spinal Can you shrug your shoulders
accessory - XI,
C3,4)
Rhomboids Push your shoulder blades together
(dorsal scapular
nerve – C4,5)
Serratus anterior The classic test is wall-press test.
(long thoracic In BPI, the patient may be unable to lift the arm.
nerve - C5,6,7) The arm should be supported by the examiner with one hand and the
patient asked to push forward as if trying to open a door. At the same
time the examiner should hold the lower pole of the scapula with
another hand.
Latissimus dorsi While the arm is supported in a flexed position, ask the patient to
(thoracodorsal push down (while the examiner palpates for musle contraction).
nerve – C6,7,8)
Deltoids (axillary Extend, abduct and flex the shoulder to test the posterior, middle and
nerve – C5,6) anterior parts respectively (unless the muscle is clearly wasted).
Demonstrate specific signs (if isolated nerve palsy suspected):
1. Swallow-tail sign
The patient is asked to extend the shoulder while
bending the trunk forward. A result of 20˚ or greater
of extension lag relative to the normal side indicates
a positive sign.
2. Abduction internal rotation
Actively and maximally abduct the shoulder in
internal rotation with the elbow flexed. Abduction lag
relative to the normal side indicates a positive sign.
2. Standing from the front
Pectoralis Clavicular Atrophy would imply lateral cord injury.
major (lateral head (C5,6) Ask the patient to touch their contralateral shoulder (and
and medial the examiner palpates for evidence of contraction).
pectoral
nerves)

Sternocostal Atrophy would imply medial cord injury.

head Ask the patient to push against the hip (and the examiner
(C7,8,T1) palpates the axillary fold).

Rotator cuffs Supraspinatus Jobe’s test

(suprascapular
nerve - C5,6)

Infraspinatus External rotation lag sign

(suprascapular
nerve - C5,6
Teres minor Hornblower test
(axillary nerve –
C5,6)
Subscapularis Belly-press sign + geber lift off test
(upper and lower
subscapular nerves
– C5,6,7)

myotomes: (more details)

1. Elbow flexion (C5,6)
2. Elbow extension (C7,8)
3. Forearm supination (C6)
4. Forearm pronation (C7,8)
 5. Wrist flexion/extension (C6,7)
6. MCPJ flexion/extension (C7,8)
7. Grip (C8)
8. Fingers abduction (T1)

1. Shoulder
Adductor of Latissimus dorsi
shoulder Pectoralis major
Coracobrachialis
Teres major
Teres minor
Infraspinatus
Abductor of Deltoid (middle)
shoulder Supraspinatus
Flexor of shoulder Pectoralis major
Deltoid (anterior)
Coracobrachialis
Extensor of Latissimus dorsi
shoulder Deltoid (posterior)
Teres major
Triceps brachii (long)
External rotation Infraspinatus
of shoulder Teres minor
Deltoid (posterior)
Internal rotation Subscapularis
of shoulder Pectoralis major
Latissimus dorsi
Teres major
Deltoid (anterior)

2. Elbow
Flexor Extensor
Biceps brachii Triceps brachii
Brachialis Anconeus provides assistance
Brachioradialis
Weak assistance from pronator

3. Wrist
Flexor Extensor
Flexor carpi radialis Extensor carpi radialis longus
Flexor carpi ulnaris Extensor carpi radialis brevis
Palmaris longus Extensor carpi ulnaris
 4. Finger
Flexor
Extensor
Abductor Dorsal interossei
Adductor Palmar interossei

Sensory
C5-lateral elbow
C6-thumb tip
C7-middle finger tip
C8-little finger tip
T1-medial elbow

Reflexes
1. Biceps - C5
2. Brachioradialis – C6
3. Triceps – C7

Pathological reflexUMNL (hoffman’s sign)

Special test – Tinel’s signs

Tapping along brachial plexus  shooting/electric sensation ( progressive regenerating nerve
after nerve compression)
Vascular – radial and brachial pulse