Less frequently, the whole brachial plexus lesion occurs;
most infrequently, sudden upward pulling on an abducted arm (as when someone breaks a fall by grasping a tree branch) produces a lower brachial plexus lesion, in which the eighth cervical (C8) and first thoracic (T1) nerves are injured "either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand and the flexors of the wrist and fingers". This results in a form of paralysis known as Klumpkes paralysis.Backpack palsy is caused by much use of a heavy backpack whose pack-straps chronically press on the brachial plexus. Mechanism
Injury to the brachial plexus can happen in numerous environments. These may include contact sports, motor vehicle accidents, and birth. Although these are but a common few events, there is one of two mechanisms of injury that remain constant during the point of injury. The two mechanisms that can occur are traction and heavy impact. Anatomy
The brachial plexus is made up of spinal nerves that are part of the peripheral nervous system. It includes sensory and motor nerves that innervate the upper limbs. The brachial plexus includes the last four cervical nerves (C5-C8) and the 1st thoracic nerve (T1). Each of those nerves splits into smaller trunks, divisions, and cords. The lateral cord includes the musculocutaneous nerve and lateral branch of the median nerve. The medial cord includes the medial branch of the median nerve and the ulnar nerve. The posterior cord includes the axillary nerve and radial nerve.
The epineurium of the nerve is contiguous with the dura mater, providing extra support to the nerve.Brachial plexus lesions typically result from excessive stretching; from rupture injury where the nerve is torn but not at the spinal cord; or from avulsion injuries, where the nerve is torn from its attachment at the spinal cord. A bony fragment, pseudoaneurysm, hematoma, or callus formation of fractured clavicle can also put pressure on the injured nerve, disrupting innervation of the muscles. A trauma directly on the shoulder and neck region can crush the brachial plexus between the clavicle and the first rib.Although injuries can occur at any time, many brachial plexus injuries happen during birth: the babys shoulders may become impacted during the birth process causing the brachial plexus nerves to stretch or tear. Obstetric injuries may occur from mechanical injury involving shoulder dystocia during difficult childbirth, the most common of which result from injurious stretching of the childs brachial plexus during birth, most often during vaginal birth, but occasionally Caesarean section. The excessive stretch results in incomplete sensory and/or motor function of the injured nerve.Injuries to the brachial plexus result from excessive stretching or tearing of the C5-T1 nerve fibers. These injuries can be located in front of or behind the clavicle, nerve disruptions, or root avulsions from the spinal cord. These injuries are diagnosed based on clinical exams, axon reflex testing, and electrophysiological testing. Brachial plexus injuries require quick treatment in order for the patient to make a full functional recovery (Tung, 2003).