Obstetric Brachial Plexus Palsy Flashcards

1
Q

pathology

A

injury to nerve roots of the brachial plexus during delivery

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2
Q

what is it?

A

2/1000most common in large babies (macrosomia in diabetes) twin deliveries shoulder dystocia - difficult delivery of shoulder after the head - compression of shoulder on pubic symphysis

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3
Q

what is the commonest palsy?

A

Erb’s palsy (C5&6)

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4
Q

what is the pathology of Erb’s palsy?

A

injury to the upper nerve roots (C5&6) - loss of motor innervation of - deltoid - supraspinatus - infraspinatus - biceps - brachialis

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5
Q

how does Erb’s palsy present?

A

internal rotation of humerus - from unopposed subscapularis Waiter’s tip posture

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6
Q

how is Erb’s palsy managed?

A

physiotherapy - prevent contractures prognosis predicted by the return of biceps function by 6 monthsgood outcome in 80-90%surgical release of contractures and tendons may be required if there is no recovery

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7
Q

what is Klumpke’s palsy (C8&T1)?

A

much rarer palsy

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8
Q

what is the pathology at klumpke’s palsy?

A

injury to the lower nerve roots (C8&T1) by forceful adduction - paralysis of the intrinsic hand muscles - +/- paralysis of finger and wrist flexors - possible horner’s syndrome - disruption of the first sympathetic ganglion from T1

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9
Q

how does Klumpke’s palsy present?

A

fingers typically flexed - paralysis of the interossei and lubricals (extension at PIP)

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10
Q

how is Klumpke’s palsy managed?

A

no specific treatment poorer prognosis - 50% recovery

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