Flashcards in Brachial Plexus Injury Deck (38):
When does a brachial plexus injury tend to occur?
during a traumatic birth
What is it called if a brachial plexus injury occurs during the process of childbirth?
Brachial Plexus birth palsy
What are the 3 risk factors for brachial plexus birth palsy?
- shoulder dystocia
- maternal diabetes (which leads to large gestational size of the infant)
- difficult delivery (vacuuming required or head gets caught during breech delivery)
What is shoulder dystocia?
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
Traction on the newborn’s shoulder during delivery of the head in a breech delivery can lead to what types of injuries?
- cervical root injury
- fractured clavicle
- broken humerus
- subluxed shoulder
In regards to cervical root injury what 3 things can happen?
- Neurotmesis: complete rupture
- Axonotmesis: disruption of the axons with intact neural sheath
- Neuropraxia: temporary nerve conduction block with intact axons
Axons grow only _ mm per day. Therefore it takes _-_ months for regeneration in the UE and _-_ months in lower arm.
What nerve roots are most commonly injured?
Although associated damage to C4 is less common it can occur which will result in what?
ipsilateral hemiparesis of the diaphragm
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
Injury to the upper roots of C5-C6 result in what diagnosis?
Describe the presentation of Erb's Palsy patients
- 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.
What movements are affected if the C7 nerve root is compromised?
Elbow and finger extension
What develops if there is injury to the upper and lower roots of the brachial plexus (C5-T1)?
What does Erb-Klumpke Palsy result in?
total arm paralysis and loss of sensation
What syndrome develops in patients with Erb-Klumpke Palsy?
Describe the symptoms of Horner's syndrome
- deficient sweating
- recession of eyeball
- abnormal pupillary contraction
Describe the observation findings in a baby with Erb-Klumpke Palsy
- Upper Extremity Neglect
- Soft tissue Contractures
- Abnormal Bone Growth
What orthopedic abnormalities tend to develop in babies with Erb-Klumpke palsy?
- Flattening of humeral head
- Shortened clavicle
- Hypoplasia of humeral head
- Abnormal glenoid fossa
If the head is habitually positioned away from the involved arm what may develop?
positional torticollis (POST)
Why do babies with Erb's palsy tend to skip the crawling/creeping stage?
they are unable to use their UEs
What is Klumpke's palsy?
Damage to only the lower roots of C7-T1
Describe the presentation of a patient with Klumpke's palsy
Shoulder and elbow movements are not impaired but the resting position of the forearm is in supination
What muscles are paralyzed in patients with Klumpke's palsy?
- wrist flexors and extensors
- intrinsic muscles of the wrist and hand
What developmental milestones may be delayed or may be skipped altogether in babies with BPIs
- 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
What are 4 neurosurgical interventions that may be performed to repair brachial plexus injuries?
- Nerve Grafting
- Neuroma Dissection and removal
- Direct end-to-end nerve anastomosis of the nerve ends
What are the 2 reasons for orthopedic surgical interventions?
What are 4 orthopedic surgical interventions used to treat BPI?
- Soft tissue releases
- Reduction of glenohumeral joint dislocations
- Transfers of muscles
A brachial plexus injury spontaneously recovers __-__% of the time
What things must be examine during the PT evaluation?
- muscle strength
What are the common UE ROM limitations in pateints with BPIs?
decreased ER and IR contractures
What UE movements are typically weak in BPI patients?
shoulder abduction and scapular stabilization (winging evident)
What UE movements are typically stronger in BPI patients?
What special test is specific to BPI?
Brachial Plexus Outcome Measure
The Brachial Plexus Outcome Measure is best used in adjunct with what other assessment tool?
Active Movement Scale
Typically it is suggested that the patient rest how long following injury and why?
7-10 days, which allows for swelling to resolve first
What types of splints are recommended in patients with BPI?
- Intermittent wrist and finger until motor function return
- Resting night splints to prevent finger contractures
- Restraining air splints to promote use of involved hand