- 5 Clinical aims of PE
- 1. Determine the level of the lesion (Pre/ Post ganglionic) (supraclavicular infraclavicular).
- 2. Determine the extent and completeness of the injury (sensory and motor deficit) with segmental injuries of the peripheral nerves - MUR
- 3. Determine the presence of any poor prognostic signs (preganglionic injuries)
- 4. Assess for recovery - Tinel's Test, Deep Muscle Squeeze Test
- 5. Look for signs of previous treatment - scars
- Look and Inspect
- Look from the sides - confirm wasting of muscles
- Neck - Cervical Scoliosis - head tilts AWAY from injured side due to paralysis of para cervical muscles
- Feel and sensation
- Feel over bony prominences for previous fractures, especially clavicle and scapular fractures
- Feel for changes down the arm associated with sweating
- Feel for radial artery as vascular structures may be compromised in severe injury
- Lift for arms and Look for axilla
- Dermatomes by ASIA Score
- Move - ASIA score
- ASIA score myotomes first - confirm which roots involved [be careful of post tendon transfers]
- "So far, i have found that the C5-C7 roots are involved, with/ without horner's syndrome. Go on to check for preganglionic involvement with muscles from the roots and drunks"
- Now, confirm pre ganglionic by Testing muscles from root and trunks (Pre-ganglionic)
- 2 muscles from roots
- 1 muscles from Trunk
- Suprascapular nerve - supraspinatus and infraspinatus
- "I want to now Check nerves for Neurotization" (2)
- Stick out tongue - hypoglossal nerve available
- Spinal Accessory nerve - check trapezius
- Ulnar nerve - for Oberlin transfer (cross fingers) or specifically FCU
- Contralateral nerves - C7 - check other limb triceps
- “Check muscles for tendon transfers” (2)
- Lat Dorsi test
- Pec Major
- LL check for previous scar/ injuries for gracillis DOI transfer
- Check recovery
- Tinel's (distal to proximal)
- Deep muscle Squeeze test = if painful on squeeze muscle, nerve is growing into motor endplate!
- Complete my exam by
- Assessing function of the UL - write, eat
- Complete walking the brachial plexus from proximal to distal
- Doing bedside tests to check autonomic function - histamine test, sweat test, wrinkle test
- Ask for Chest XR, Cervical XR
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