Brachial Plexus Injury

Question 1

When does a brachial plexus injury tend to occur?

Answer 1

during a traumatic birth

Question 2

What is it called if a brachial plexus injury occurs during the process of childbirth?

Answer 2

Brachial Plexus birth palsy

Question 3

What are the 3 risk factors for brachial plexus birth palsy?

Answer 3

• shoulder dystocia
• maternal diabetes (which leads to large gestational size of the infant)
• difficult delivery (vacuuming required or head gets caught during breech delivery)

Question 4

What is shoulder dystocia?

Answer 4

after the delivery of the head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the mother’s pubic symphysis

Question 5

Traction on the newborn’s shoulder during delivery of the head in a breech delivery can lead to what types of injuries?

Answer 5

• cervical root injury
• fractured clavicle
• broken humerus
• subluxed shoulder

Question 6

In regards to cervical root injury what 3 things can happen?

Answer 6

• Neurotmesis: complete rupture
• Axonotmesis: disruption of the axons with intact neural sheath
• Neuropraxia: temporary nerve conduction block with intact axons

Question 7

Axons grow only _ mm per day. Therefore it takes - months for regeneration in the UE and - months in lower arm.

Answer 7

1

4-6

7-9

Question 8

What nerve roots are most commonly injured?

Answer 8

C5-C6

Question 9

Although associated damage to C4 is less common it can occur which will result in what?

Answer 9

ipsilateral hemiparesis of the diaphragm

Question 10

Birth weight is the most important risk factor and it has been found that babies with a birth weight over __ lbs are 45 times more likely to acquire a BPI than infants weighing less than 7.7 lbs

Answer 10

9.9

Question 11

Injury to the upper roots of C5-C6 result in what diagnosis?

Answer 11

Erb’s Palsy

Question 12

Describe the presentation of Erb’s Palsy patients

Answer 12

• The shoulder is usually held in extension, IR, and adduction.
• The elbow is extended, the forearm is pronated and the wrist and fingers are flexed (“waiter’s tip” position).
• Grasp is intact but sensory loss may be present.

Question 13

What movements are affected if the C7 nerve root is compromised?

Answer 13

Elbow and finger extension

Question 14

What develops if there is injury to the upper and lower roots of the brachial plexus (C5-T1)?

Answer 14

Erb-Klumpke Palsy

Question 15

What does Erb-Klumpke Palsy result in?

Answer 15

total arm paralysis and loss of sensation

Question 16

What syndrome develops in patients with Erb-Klumpke Palsy?

Answer 16

Horner’s syndrome

Question 17

Describe the symptoms of Horner’s syndrome

Answer 17

• deficient sweating
• recession of eyeball
• abnormal pupillary contraction

Question 18

Describe the observation findings in a baby with Erb-Klumpke Palsy

Answer 18

• Upper Extremity Neglect
• Soft tissue Contractures
• Abnormal Bone Growth

Question 19

What orthopedic abnormalities tend to develop in babies with Erb-Klumpke palsy?

Answer 19

• Flattening of humeral head
• Shortened clavicle
• Hypoplasia of humeral head
• Abnormal glenoid fossa

Question 20

If the head is habitually positioned away from the involved arm what may develop?

Answer 20

positional torticollis (POST)

Question 21

Why do babies with Erb’s palsy tend to skip the crawling/creeping stage?

Answer 21

they are unable to use their UEs

Question 22

What is Klumpke’s palsy?

Answer 22

Damage to only the lower roots of C7-T1

Question 23

Describe the presentation of a patient with Klumpke’s palsy

Answer 23

Shoulder and elbow movements are not impaired but the resting position of the forearm is in supination

Question 24

What muscles are paralyzed in patients with Klumpke’s palsy?

Answer 24

• wrist flexors and extensors

- intrinsic muscles of the wrist and hand

Question 25

What developmental milestones may be delayed or may be skipped altogether in babies with BPIs

Answer 25

• reaching and grasping
• prone –> sit done to one side resulting in asymmetrical stretching and delayed balance reactions
• creeping may mot occur
• scooting may be the main form of locomotion until walking is established

Question 26

What are 4 neurosurgical interventions that may be performed to repair brachial plexus injuries?

Answer 26

• Nerve Grafting
• Neuroma Dissection and removal
• Neurolysis
• Direct end-to-end nerve anastomosis of the nerve ends

Question 27

What are the 2 reasons for orthopedic surgical interventions?

Answer 27

• contractures

- deformities

Question 28

What are 4 orthopedic surgical interventions used to treat BPI?

Answer 28

• Soft tissue releases
• Reduction of glenohumeral joint dislocations
• Transfers of muscles
• Osteotomies

Question 29

A brachial plexus injury spontaneously recovers __-__% of the time

Answer 29

66-73%

Question 30

What things must be examine during the PT evaluation?

Answer 30

• ROM
• muscle strength
• sensation

Question 31

What are the common UE ROM limitations in pateints with BPIs?

Answer 31

decreased ER and IR contractures

Question 32

What UE movements are typically weak in BPI patients?

Answer 32

shoulder abduction and scapular stabilization (winging evident)

Question 33

What UE movements are typically stronger in BPI patients?

Answer 33

IR

Question 34

What special test is specific to BPI?

Answer 34

Brachial Plexus Outcome Measure

Question 35

The Brachial Plexus Outcome Measure is best used in adjunct with what other assessment tool?

Answer 35

Active Movement Scale

Question 36

Typically it is suggested that the patient rest how long following injury and why?

Answer 36

7-10 days, which allows for swelling to resolve first

Question 37

What types of splints are recommended in patients with BPI?

Answer 37

• Intermittent wrist and finger until motor function return
• Resting night splints to prevent finger contractures
• Restraining air splints to promote use of involved hand

Question 38

What movements should be emphasized during treatment of a BPI patient?

Answer 38

• abduction
• ER
• elbow flexion
• supination