Brachial Plexus Injury Flashcards
(32 cards)
What is brachial plexus injury?
an injury to one or more of the spinal nerves in the UE
OBPI
obstetrical brachial plexus injury
Erb’s Palsy
○ Most common BPI
○ Involves damage to the spinal nerve C5 to C6 and possibly C7
Erb’s palsy results in
Paralysis or weakness in the shoulder muscles, the elbow flexors, and the forearm
supinators (waiter’s tip)
Klumpke’s Palsy
Avulsion of the lower spinal roots, C8-T1, pure lower root injuries are rare
Klumpke’s palsy results in:
■ Weakness of triceps, forearm pronators, and wrist flexors
■ “Claw-like” paralysis of the hand
■ Horner’s syndrome may be present
Erb-Klumpke
○ second most common OBPI ○ injury to the complete plexus – C5-T1
Erb-Klumpke Results in:
■ Total sensory and motor deficits of the entire upper extremity
■ Flail, paralyzed, areflexic arm with no sensation
Prevalence
- vertex presentation with shoulder dystocia accounts for most OBPI cases
- R > L
Etiology
● Shoulder dystocia
● Large birth weight
● Breech delivery
● Diabetes in pregnancy
● Maternal small stature/small pelvis
● Prolonged second stage of labor
● Multiple fetuses
● Use of forceps/vacuum to deliver
Types of BPI - Avulsion
Complete tear at proximal root
Types of BPI - Rupture
more distal on the nerve
Types of BPI - neuroma
scar tissue
types of BPI - Neuropraxia or stretch
just stretched
good recovery
Pathophysiology
● OBPI results from excessive lateral traction on the head away from the shoulder during
delivery
● Spontaneous recovery occurs with remyelination and reinnervation of sensory
receptors and/or muscle endplates
● Neonate more susceptible to nerve injury than older child
Narakas Classification - Group 1
C5,6: paralysis of shoulder, absent elbow flexion – spontaneous recovery in >80%.
Narakas Classification - Group 2
C5,6,7: As above with wrist drop – good hand, good shoulder and elbow in 60%
Narakas Classification - Group 3
All: complete paralysis – good hand in most, good shoulder and elbow in 30–50%
Narakas Classification - Group 4
All: complete paralysis, Horner sign, limb atonic – full recovery very unlikely
Diagnosis
● Typically first noticed by nurse or neonatologist
● Neonate should be examined in supine: movements, primitive reflexes, sensory, function, face and scalp presentation, respiratory status
● Confirmed through diagnostic tests
Diagnostic Tests
● X-rays – clavicle and humerus
● Ultrasound
● EMG/NCS – 4 weeks of age
● CT scan with contrast-older child
● MRI – older child
PT Examination
- AROM/PROM
- Strength and motor function
- sensation: sensory grading system
- Development: symmetry of reflexes
Strength and motor function testing
- toronto active movement scale
- Mallet’s Classification of function
- Raimondi score for hand function
Sensory grading system for children with BPI
S0 – no reaction to painful or other stimuli
S1 – reaction to painful stimuli, none to touch
S2 – reaction to touch, not to light touch
S3 – apparently normal sensation
