Flashcards in Brachial Plexus Deck (33):
Brachial plexus is responsible for:
The motor innervation to upper limb, except trapezius and levator scapula The sensory innervation of the upper limp except an area just above the point of the shoulder
What make brachial plexus?
Roots, trunks, divisions, cords, and terminal branches (muslculo-cutaneous n., ulnar n., median n., axillary n., radial n.
what is a brachial plexus injury?
Brachial plexus injury is an injury to the network of nerves that send signals from the spine to the shoulder, arm, and hand.
What are the two ways an injury occurs?
When nerves are stretched, or in more serious cases they are torn (avulsion)
When the shoulder is being pressed down forcefully while the head is pushed up and away from the shoulder
What is happens in avulsion?
the nerve root is torn from the spinal cord
common activities/ events that injury to the brachial plexus occurs:
Falls, contact sports, MVA, during birth, or inflammation or tumors
•Weakness, disability, burners and stingers, weakness in hand or arm, neck pain
Symptoms for less severe injuries:
Less-severe injuries: Electric shock or burning sensation down arm, shooting down arm, lasts seconds or minuets, numbness or weakness
Symptoms for more severe injuries:
•More-severe injuries: Tear or rupturing of nerves
True or False: No damage occurs to the lower nerves when the shoulder is forced down, and the neck stretches up and away from the injured shoulder.
FALSE: upper nervesDamage to the upper nerves if the shoulder is forced down, and the neck stretches up and away from the injured shoulder
True or False: Damage occurs to the lower nerves if an arm is forced above the head.
TRUEDamage to lower nerves if arm is forced above the head
What are common complications with the injury?
muscle atrophy, pain, stiff joints, loss of feeling (there are more, reference notes to see the rest)
True or False: It is important to be mindful of the patient's pain when conducting session.
True: this will also help you build trust with your patient
What is the prognosis of the injury dependent on?
Type, location and severity of the injury
Even with surgery, some people experience permanent disability, ranging from weakness in the hand, shoulder or arm to paralysis
Does Erb-Duchenne Palsy affect the superior or inferior part of the plexus?
superior part of the plexus
How does Erb-Duchenne occur?
Due to excessive increase in the angle b/t the neck and shoulder: nerve roots C5,C6 involved and muscles of the shoulder and arm
True or false: waiter's tip position is involved in Erb-Duchenne?
True:•Waiter’s tip position:
Characteristic position: adducted and internal rotation of the arm with forearm pronatedoForearm extension normal Biceps reflex absent
What is the clinical appearance of Erb- Duchenne?
Clinical appearance:• Adducted shoulder• Medially rotated arm• Extended elbow
Also see a sensory loss on the lateral aspect of the upper limb( uncommon)• Waiter’s tip position:
what is Klumpke Paralysis or Palsy?
Injury to inferior part of plexus
How does Klumpke Paralysis occur?
•Excessive abduction of the arm
Less common then injury to the superior part of the plexus• Could occur from a person grasping something to prevent a fall (tree branch or birth)
Is Klumpke Paralysis a superior or inferior injury of the brachial plexus?
Inferior:Roots involved: C8 and T1
• Motor loss: small muscles of the hand• Sensory loss: medical aspect of the upper limb
What aspect of the plexus is injured in claw hand?
•Plexus lesion (C8-T1) ulnar, and/or median n. injury
Clinical appearance of claw hand:
All fingers are clawed
Hyperextension at the mcp joints, flexion at the ip joints
True or False: Cervical rib is common, especially in the elderly.
False:It is a rare condition
Does cervical rib involve the superior or inferior aspect of the plexus?
it involves the inferior part of plexus
What types of treatment can be done for an injury to the brachial plexus?
Surgery repair due to the risk of muscle atrophy
Within how much time should the surgery be done?
3-6 mo. after the injury
If wait more than 1year after injury, the success rate drops
How fast does nerve tissue grow?
Nerve tissue grows slowly ( about 1 inch/month)
How long could it take to recover from surgery?
can take several years to fully recovery after surgery
True or False: It is important to respect the pt's pain?
True: Pain must be respected
Occupational therapy goals:
Minimizing boney deformities and joint contractures, while optimizing functional outcomes
Passive and active ROM exercise