mjl1717
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if it can be said in words: the hand is is a flexed position behind the back, the posterior forearm is resting on the gluteus maximus. in laymans terms :think of a hotel room service waiter leaving your room with his back towards you and inconspicuously placing his bent (flexed) hand in such a way as to recieve a tip(gratuity) from a well to do doc or lawyer, or patron. Now someone else say which nerve and trunk of brachial plexus is involved in this??
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| mjl1717
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is that all? what about roots , trunk, divisions, cord, and nerve branch??
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| DrVirgo
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Injury of C5 and C6 (upper trunk) occurs due to something falling on patient from above and is called Erb's Paralysis which presents with Watier's Tip.
SAM the Waiter wants a tip:
Suprascapular, Axillary, and Musculocutaneous (those are the nerves affected)
Loss of intrinsic muscles of shoulder and loss of muscles of anterior arm.
mjl described how it looks very well. 
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| mjl1717
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Great 
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| zaidsuror
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There is a better way of understanding the cause and the presentation of this disease:
1-first of all muscles of the shoulder are innervated by segments c5-c6(i.e upper trunk).
2-of all the functions carries out by shoulder muscle the two most imp are (ABDUCTION AND EXTERNALL ROTAION).
So when we have an injury to an upper trunk (fall on the side of the neck and shoulder with the head tilted to other side stretching the upper trunk) we will have loss of the 2 functions causing (ADDUCTION AND INTERNAL ROTATION.
MAY THE FORCE BE WITH U ALL.
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| DrVirgo
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Zaid, that is a great explanation of upper trunk injury.
Can you please also explain lower trunk function and injury. As i know it, it results from a violent stretch of the arm upwards (e.g. man falling from a building and tries to grab a tree branch) which will injure the lower trunk leading to Klumpke's paralysis... can you please add to this: whats is the presentation, which nerves involved, etc. thanks.
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| reet
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in klumPke;s MEDIAN AND ULNAR NERVE INVOLVEMENT..
loss of fuction of wrist and hand with horner synderome ( cuz ulnar nerve has T1 sympth component)
MEDIAN SUPPLY FLEXOR COMPARTMENT and sensory loss on dorsal/palmar side of INDEX,MIDDLE FINGER,,half ring fing.
ULNAR nerve injury would be with loss of ADDUCTION ,ABDUCTION of FINGRES. ask patient to hold paper in finger between middle finger and ring finger.
..there is a lot more to add...
ADD PLZ
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| DrVirgo
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Yes, injury of lower trunk (C8, T1)leads to injury of median and ulnar with a possible combination of ape and claw hand and Horners's Syndrome.
What is meant by "Thoracic Outlet Syndrome" This also has to do with injury of the lower trunk?
What are the symptoms/presentation?
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| zaidsuror
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Reet did a good and detailed explanation of the presentation.to sum it all up,when you face a functional disturbance( a lower motor one) that can be attributed to more than one nerve you have to think WHAT IS THERE IN COMMON?THE ANSWER IS THE SEGMENTAL VALUE,AND IN THE HAND IT IS C8-T1.EXAMPLE: calw and ape hand (ulnar and median nerve) so DEFECT ATRIBUTED TO MORE THAN ONE NERVE THAT SHARE A SEGEMTAL VALUE OF C8-T1.WHERE DO HAVE A FIBERS OF C8 AND T1 THAT END UP IN ULNAR AND MEDIAN (UPPER TRUNK).THE MECHANISM IS LIKE DRVIRGO MENTIONED.IT CAN ALSO RESULT FROM BIRTH INURY.
Edited by zaidsuror on 02/19/06 - 06:24 AM
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| zaidsuror
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Regarding thoracic outlet syndrom.It is cause by the presence of a cervical rib.The consequences of that are compression on both the lower trunk and the subclavian vessels causing neurological and vascular problems.What makes the lower trunk particularly vulnerable is that it arises from foramena between c7 and t1 and between t1 and t2,in other words from the thorax so it has to ascend up into the neck and over the first rib and then descend to the axilla .in this sense it is liable to compression in the presence of a cervical rib.
MAY THE FORCE BE WITH U.
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| mjl1717
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Great explanations!!!
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