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BRACHIAL PLEXUS INJURY

Out-patient Departement
Upper Extremity Discussion
Friday, 22 October 2015
Tim PPDS Stase Hand : KUH/YSW/DDQ/MRQ/ONO
Patient Identity
• Name : Junaidi
• Age/ sex : 14 y.o/male
• Address : Tenggina RT02/03, Slopeng,
Dasuk Sumenep
• Phone number : 081913652903
• E-mail :-
• Last occupation : Student
• Dominance hand : Right
Chief Complain
• Unable to move his left arm
History Taking (1)
• Mode of Injury : Single MVA, falling from motorcycle
• Date of accident : January 2015
• Associated injury:
 B1 : (-)
 B2 : (-)
 B3 : (-)
 B4 : (-)
 B5 : (-)
 B6 : Left shoulder dislocation
• Treated by bone setter
History Taking (2)
• Rehabilitation
 In RSUD Sumenep, March 2015
 Slight improvement in shoulder flexion
General Status
• Head/ neck : Horner syndrome (- )
 Anhidrosis (-)
 Ptosis (-)
 Enophtalmus (-)
 Miosis (-)
• Thoracic : Symmetric
• Abdomen : Soepel, flat, normal intestine movement
• Extremity : in region: see local status
Local Status
• LOOK :
 Muscle atrophy (+)
 Scar (+)

• FEEL :
 See Motoric and Sensory Examination

• MOVE :
 See ROM table
MOTORIC EXAMINATION
Level Nerve Muscle Right Left
Accesorius (XIN) Trapezius 5 5
Dorsal Scapular (DSN) Rhomboids 5 3
Root Winging
Long Thoracic (LTN) Serratus Anterior 4
scapula (-)
Trunk Suprascapular (SSN) Supraspinatus 5 2
Division - - - -
Lateral Pectoral (LPN) Pectoralis Major 5 4
Cord Medial Pectoral (MPN) Pectoralis Minor 5 4
Thoracodorsal (TDN) Latissimus Dorsi 5 2
Axillaris (AXN) Deltoid 5 2
Musculocutan (MCN) Biceps 5 1
Branch Radialis Triceps/EPL/ECRL 5/5/5 1
Medianus FCR/FPL 5/5/5 0
Ulnaris FCU/Interosseus 5/5/5 0
Local Status Left Upper Extremity
MOVE: ROM active (-), passive : free ROM
Nerve Movement Right Left

C5 Shoulder Abduction 5 1

Elbow Flexion 5 2
C6 Wrist extension 5 0

Elbow Extension 5
C7 Wrist Flexion 5
0

0
C8 Finger Flexion 5
0

Finger Adduction 5 1
Th 1 Finger Abduction 5 1
SENSORIC EXAMINATION
• Anesthesia
• Hypesthesia

• Level
 C4 within normal limit
 C5 hypoasthesia
 C6 hypoasthesia
 C7 hypoasthesia
 C8 hypoasthesia
 T1 hypoasthesia
 T2 hypoasthesia
ROM Table
ROM RIGHT LEFT
Active Passive Active Passive
Shoulder Abduction 0-180 0-180 0 - 10 0-180
Shoulder Adduction 0-45 0-45 - 0-45
Shoulder Int-Rotation 0-90 0-90 - 0-90
Shoulder Ext-Rotation 0-90 0-90 - 0-90
Shoulder Flexion 0-180 0-180 0 – 20 0-180
Shoulder Extension 0-60 0-60 - 0-60
Elbow Flexion 0-140 0-140 - 0-140
Elbow Extension 0-10 0-10 - 0-10
Wrist Flexion 0-80 0-80 - 0-80
Wrist Extension 0-80 0-80 - 0-80
Ulnar deviation 0-40 0-40 - 0-40
Radial deviation 0-10 0-10 - 0-10
Supination 0-90 0-90 - 0-90
Pronation 0-90 0-90 - 0-90
ROM table
RIGHT LEFT

Active Passive active passive

MCP Joint Flexion 0-85 0-85 - 0-85

MCP Joint Extension 0-40 0-40 - 0-40

PIP Joint Flexion 0-90 0-110 - 0-110

PIP Joint Extension 0 0 - 0

DIP Joint Flexion 0-40 0-80 - 0-80

DIP Joint Extension 0-20 0-20 - 0-20


Clinical Findings (Date: 09/10/15)
Clinical Findings (Date: 09/10/15)
• VIDEOS
Radiological Findings
EMG/NCV/SSEP (Date: 05 August 2015)
• Left brachial plexus injury C5-T1 post ganglionic at
the level distal to branch of suprascapular nerve and
proximal to branch of lateral pectoral nerve
• C5-C7 components showed partial denervation and
C8-T1 showed total denervation
Branch
Diagnosis
• Complete left brachial plexus injury from C5-T1 post
ganglionic
Plan/ Discussion Result