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  • Before and After TT
  • Bony Improvement - Before and After - Mod-Quad and TT

Anatomy of the Injury (Brachial Plexus Injury)

Brachial plexus anatomy is complex, but can be described in terms of basic function. The brachial plexus is derived from 5 "roots" or spinal nerves that exit the spinal cord in the neck. The nerves then pass through the axilla or armpit behind the collarbone (clavicle), and split into the final nerve branches that supply the muscles and skin of the shoulder, arm, elbow and hand.

The roots are named for the level of spinal cord that they exit. The upper roots (C5 and C6) exit from the cervical (meaning "neck") 5th and 6th vertebrae. The middle root (C7) exits above the 7th cervical vertebrae, and the lower roots exit from C8 (below the 7th cervical vertebra) and T1 (below the 1st thoracic vertebra). The upper roots supply upper structures (C5 to shoulder, C6 and C7 to elbow), and the lower roots supply the forearm and hand.

Brachial Plexus Anatomy Diagram, Erb's palsy Injury, Anatomy of Brachial Plexus

Injury to upper roots (the most common injury) is known as Erb’s palsy after the physician who described it. Erb’s palsy (paralysis) affects the shoulder and elbow, because the upper roots supply these structures. Injury to the lower roots is known as Klumpke’s paralysis, but is relatively uncommon, and very rarely exists by itself. Because the lower roots are injured, the hand is predominantly affected. If the lower roots are injured, the injury is generally so severe that all the roots of the plexus are involved, and the injury includes all parts of the arm. Upper root (Erb’s) injury is seen about 60% of the time, isolated Klumpke’s perhaps 5% of the time, and mixed injuries involving all elements of the plexus to some degree, make up 35% of patients.

Brachial Plexus Erb’s palsy , Brachial Plexus Anatomy Diagram, Erb's palsy Injury, Anatomy of Brachial Plexus

The mechanism of injury to the upper roots is thought to be a bending or stretching of the neck in a direction away from the side of injury. Lower root injury is thought to be caused by pulling up of the arm above the head, so that stretch on the C8 and T1 roots results. Injuries can occur in both children and adults, and similar mechanisms are apparently responsible.

The upper roots happen to be firmly fixed to the bony sides of the spine, and so they tend to be torn in this region. These injuries can be repaired in a relatively straightforward manner.

Lower roots by circumstances of anatomy do not have support by bony structures, and therefore are unprotected and tend to be torn out of the spinal cord. These injuries cannot be directly repaired and other techniques of reconstruction must be employed.

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Association of BPI Therapists

The Association of
Brachial Plexus Therapists
would like to provide
a means for therapists..
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