arm cannot be raised from the side; all power of flexion of the elbow is lost, as is also supination of the forearm". In Klumpke's paralysis, a form of paralysis involving the muscles of the forearm and hand, a characteristic sign is the clawed hand, due to loss of function of the ulnar nerve and the intrinsic muscles of the hand it supplies. Causes In most cases, the nerve roots are stretched or torn from their origin, since the meningeal covering of a nerve root is thinner than the sheath enclosing the nerve. The epineurium of the nerve is contiguous with the dura mater, providing extra support to the nerve. Brachial plexus lesions typically result from excessive stretching; from rupture injury where the nerve is torn but not at the spinal cord; or from avulsion injuries, where the nerve is torn from its attachment at the spinal cord. A bony fragment, pseudoaneurysm, hematoma, or callus formation of fractured clavicle can also put pressure on the injured nerve, disrupting innervation of the muscles. A trauma directly on the shoulder and neck region can crush the brachial plexus between the clavicle and the first rib. Although injuries can occur at any time, many brachial plexus injuries happen during birth: the baby's shoulders may become impacted during the birth process causing the brachial plexus nerves to stretch or tear. Obstetric injuries may occur from mechanical injury involving shoulder dystocia during difficult childbirth, the most common of which result from injurious stretching of the child's brachial plexus during birth, most often during vaginal birth, but occasionally Caesarean section. The excessive stretch results in incomplete sensory and/or motor function of the injured nerve. Injuries to the brachial plexus result from excessive stretching or tearing of the C5-T1 nerve fibers. These injuries can be located in front of or behind the clavicle, nerve disruptions, or root avulsions from the spinal cord. These injuries are diagnosed based on clinical exams, axon reflex testing, and electrophysiological testing. Brachial plexus injuries require quick treatment in order for the patient to make a full functional recovery (Tung, 2003). These types of injuries are most common in young adult males. Traumatic brachial plexus injuries may arise from several causes, including sports, high-velocity motor vehicle accidents, especially in motorcyclists, but also all-terrain-vehicle (ATV) and other accidents. Injury from a direct blow to the lateral side of the scapula is also possible. The