A 55-year-old male firefighter is admitted to the hospital after blunt trauma to his right axilla. Examination reveals winging of the scapula and partial paralysis of the right side of the diaphragm. Which of the following parts of the brachial plexus have been injured?
**Core Concept:** The brachial plexus is a network of nerves that consists of interconnected roots from cervical, thoracic, and lumbar spinal nerves. It plays a crucial role in the innervation of the upper limb muscles and sensory functions. The brachial plexus has three major divisions: C5-C8 and T1 roots form the **supraclavicular plexus** which innervates the supraspinatus, infraspinatus, teres minor, subscapularis, and deltoid muscles; C5-C8 and T1 roots form the **trunk** which innervates the deltoid, biceps, and brachialis muscles; and the C8-T1 roots form the **radial nerve** which innervates the triceps and forearm muscles.
**Core Concept (Expanded):**
The brachial plexus is a complex network of nerves that extend from the cervical, thoracic, and lumbar spinal nerves. The brachial plexus is responsible for controlling the muscles and sensory functions in the upper limb. The brachial plexus has three major divisions: the **supraclavicular plexus**, the **trunk**, and the **radial nerve**.
**Why the Correct Answer is Right:**
In the given scenario, the patient presents with winging of the scapula and partial paralysis of the right side of the diaphragm. This suggests an injury to the **supraclavicular plexus** as it is responsible for innervating the muscles associated with these symptoms: the supraspinatus, infraspinatus, teres minor, subscapularis, and deltoid muscles.
**Why Each Wrong Answer is Incorrect:**
A) The suprascapular nerve, which is a branch of the supraspinatus nerve, is responsible for innervating the supraspinatus muscle. A suprascapular nerve injury would not explain the described symptoms as the injury should affect the supraspinatus muscle directly.
B) The median nerve, which is responsible for innervating the flexor muscles of the forearm, is not the correct answer. The described symptoms are related to the upper limb, not the forearm.
C) The ulnar nerve, which is responsible for innervating the flexor muscles of the forearm, is also not the correct answer. The described symptoms are related to the upper limb, not the forearm.
D) The radial nerve, which is responsible for innervating the extensor muscles of the forearm, is incorrect since the described symptoms are related to the upper limb, not the forearm.
**Clinical Pearls:**
1. Injuries to the brachial plexus can result in winging of the scapula and weakness of the deltoid, biceps, and triceps muscles.
2. Suspect brachial plexus injuries when examining a patient with winging of the scapula and weakness of the deltoid, biceps, and triceps muscles.
3. The suprascapular nerve, median nerve, ul