Brachial plexus lesions: Anatomical knowledge as an essential diagnostic tool in a situation of limited imaging facilities

Abstract

Diagnosing brachial plexus lesion is a challenge in countries where imaging facilities are not well developed. Here we report 3 cases of different lesions of the brachial plexus sustained after a road traffic crush. The first case presented with a lesion of the 3 primary trunks of the right brachial plexus. The clinical examination showed paralysis of all terminal nerves of the brachial plexus and the collateral branches of both anterior and posterior brachial plexus. The second patient showed paralysis of all muscles of the shoulder and muscles of the anterior compartment of the arm. This clinical feature is in accordance of the upper brachial trunk lesion. The third patient had paralysis of muscles of the hand being innerved by median nerve or ulna nerve. He showed also paralysis of muscles of the anterior compartment of the forearm and anaesthesia of the medial region of hand and forearm. This clinical feature was in conformity with a lesion of inferior primary trunk. All diagnoses were made based on the clinical findings. These cases demonstrate the significance of a through anatomical knowledge in the clinical examination if one has to avoid confusing the signs of terminal nerves lesion with the trunk’s lesion. These cases underscore the importance of applied anatomy in clinical situations.