Brachial plexopathy

18 ♂ RHD, ATV accident 4/12 ago, Persistent severe R arm weakness. On Examination, severe atrophy – supraspinatus, infraspinatus, deltoid, biceps. Strength: Deltoid – 0, Shoulder ER – 0, Biceps – 0, Triceps – 4+, Finger flexors / extensors, 1st DI, APB – 5/5. Decreased sensation lateral shoulder, lateral forearm and into thumb

What's the pattern?

• upper trunk plexopathy

• lower trunk plexopathy

• pan-plexopathy/nerve root avulsion

• neuralgic amyotrophy

Which reflexes would be abnormal in this patient? Select all that apply

• Triceps

• biceps

• brachioradialis

• finger flexors

Which muscles, if abN on needle EMG would make brachial plexopathy less likely? Select all that apply

• Rhomboids

• supraspinatus

• serratus anterior

• paraspinals

When is the ideal time to operate post-injury

• 3 months

• 5 months

• 9 months

• 12 months

36 ♀ presents with approx 2 yr history of hand weakness & numbness. Physical Examination: Atrophy of thenar eminence>hypothenar eminence, FDI, ↓ sensation medial forearm, digits 4 & 5, weakness of finger abduction / finger adduction / APB / thumb opposition, 5/5 strength delt / bi / tri / WE / WF / FF / FE. What's the pattern?

• upper trunk plexopathy

• lower trunk plexopathy

• pan-plexopathy/nerve root avulsion

• neuralgic amytrophy

which reflexes would be affected in this type of injury? Select all that apply.

• triceps

• biceps

• brachioradialis

• finger flexors

which nerve conduction studies would be helpful to differentiate from radiculopathy? Select all that apply.

• Medial antebrachial cutaneous sensory study

• Ulnar sensory to D5

• median sensory to D2

• DUC sensory

35 ♂ with unremarkable PMHx, woke up with severe pain in R shoulder, radiating down arm 1/12 ago, No antecedent trauma or change in activity pattern, Severe pain lasted 3 days, and then began to decrease, As pain ↓, pt noticed arm and hand weakness, Still left with moderate pain down arm (diffusely). On Exam, atrophy deltoid, infraspinatus, winging R scapula, Delt / ER 1, IR 4, Elbow flex 3, Ext 4, FE 4, FDP dig 2 & 3 – 1/5, FPL 1/5, Pronation 4/5 (elbow @ 30°), sig weaker when elbow fully flexed, FDP dig 4 & 5 – 4/5, 1st DI & APB  4/5, Sensation ↓ over lateral shoulder, Reflexes grade 1 R arm, 2+ L arm. What's the pattern?

• upper trunk plexopathy

• lower trunk plexopathy

• pan-plexopathy/nerve root avulsion

• neuralgic amyotrophy

What is a treatment for neuralgic amyotrophy? Select all that apply.

• prednisone

• NSAIDs

• IVIg

• Nerve transfers

25M RHD in snowmobile accident 3/12 ago, Flail R arm, No units present in any arm muscle on EMG, Relative sensory sparing on NCS. What's the pattern?

• upper trunk plexopathy

• lower trunk plexopathy

• pan-plexopathy/nerve root avulsion

• neuralgic amyotrophy