Brachial Plexus Injury, Torticollis and Plagiocephaly Flashcards
What is the incidence of brachial plexus injuries in newborn babies? How many of these involve permanent damage?
1.3 to 1.5 in every 1000 births, of which 10-23% are permanent
What is the brachial plexus?
A complex network of nerves arising from the cervical spine and across the shoulder to the upper limb.
What classification is used to grade the severity of NBPP and for prognosis?
Gilbert and Tassin/Narakas classification scheme
What are the four groups of the Gilbert and Tassin/Narakas classification scheme?
I: C5&6 (deltoid and biceps), ~90% rate of full spontaneous recovery
II: C5-C7 (deltoid, biceps, triceps and wrist extensors), ~65%
III: C5-T1 (flail arm), <50%
IV: C5-T1 (flail arm with Horners syndrome), ~0%
What does a neuropraxia transient nerve injury involve?
Brief, ischemic episode caused by compression, demyelination, axonal constriction or stretch
What does an axonotmesis transient nerve injury involve?
Permanent nerve injury, with disruption to the axonal nerve fibres.
How does a brachial plexus injury present clinically?
- Shoulder extension, IR and adduction
- Elbow extension
- Forearm pronation
- Wrist and finger flexion
- Grasp intact
- Sensory loss present
- Paralysis present
What observations need to be made during the assessment of a suspected brachial plexus lesion?
- Spontaneous movements
- Passive and active range
- Active range with stimulation: stroking, tapping, vibrations
- Against and across gravity
- Scapula winging weight bearing on UL and head position in prone
- Chest expansion (phrenic nerve)
- Reflexes
- Sensory responses in dermatomal pattern e.g. rash
What observations need to be made during the assessment of a suspected brachial plexus lesion?
- Spontaneous movements
- Passive and active range
- Active range with stimulation: stroking, tapping, vibrations
- Against and across gravity
- Scapula winging weight bearing on UL and head position in prone
- Chest expansion (phrenic nerve)
- Reflexes
- Sensory responses in dermatomal pattern e.g. rash
What standardised assessments can be used for suspected brachial plexus injury?
- Active Movement Scale (AMS) for Newborns
- The Mallet scale for children
- PEDI
What medical assessments can be conducted to test for a suspected brachial plexus injury?
- Electrodiagnostic examination
- Nerve conduction studies
- EMG
- CT
- MRI
What should the treatment of a brachial plexus injury involve?
- Protect arm
- Pain relief if required
- Review in 2 weeks
- Introduce gentle range of motion exercises and stimulation exercises from 2/52
- Developmentally appropriate stimulation e.g. tummy time
How can active ROM exercise be progressed?
- Initially stroking, tapping or vibrating in gravity eliminated position
- Then anti-gravity
- Then in weight bearing position, developmentally appropriate for the child
What is congential muscular torticollis (CMT)?
A postural deformity , evident at birth, resulting from unilateral shortening and fibrosos of sternocleidomastoid muscle.
What is the incidence of congential muscular torticollis? What association is there with hip dysplasia?
- 4-2%.
12. 5% incidence of hip dysplasia in babies with CMT.
