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brachial plexus emerging from interscalene triangle
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1. Damage to the upper root of the brachial plexus (C5-C6), occurring during movements where the head and shoulder are pulled apart, may result in Erb-Duchenne syndrome. If this occurs the person will be unable to abduct and laterally rotate the shoulder and flex the elbow, and also experience weakness when attempting to supinate the forearm. The resulting position of the upper limb is limp at the side with the elbow extended, arm medially rotated, and the forearm pronated – the so-called “waiter’s tip.” The 2 nerves affected by Erb-Duchenne syndrome are the suprascapular nerve (off the superior trunk) and the musculocutaneous nerve (C5-C7).

2. Damage to the lower root (C8-T1) of the brachial plexus may result in Klumpke syndrome and typically occurs with strong upward traction of the upper limb. Motions of the wrist and hand are affected due to paralysis of the muscles of the forearm and hand innervated by the ulnar nerve, as well as paralysis of intrinsic hand muscles and the FDP (flexor digitorum profundus) innervated by the median nerve.

3. Pancoast syndrome can occur when a tumor (Pancoast tumor) develops in the apex of the lung (especially the posterior portion) and compresses the lower trunk of the brachial plexus or the T1 sympathetic ganglion (or stellate ganglion). This results in pain, numbness, and weakness in the areas innervated by these structures. Horner’s syndrome-like symptoms can also be observed approximately 20% of the time (ipsilateral ptosis, miosis, anhidrosis, etc.).
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