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Pediatrics > Brachial plexus injury > Flashcards

Brachial plexus injury Flashcards

1
Q

brachial plexus injury etiology and incidence

A
  • injury to the brachial plexus usually during a difficult vaginal delivery. forceful traction and rotation of the head tends to injure the C5-C6 nerve root
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2
Q

contributing factors of a brachial plexus injury

A
  • birth weight greater than 3500 g
  • difficult delivery of the shoulder
  • prolonged maternal labor
  • maternal diabetes
  • sedated hypotonic infant during delivery
  • breech delivery
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3
Q

neurotemesis

A
  • complete rupture. may develop into a neuroma or a mass of fibrous tissue
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4
Q

axonotemesis

A

-disruption of the axon while the sheath remains intact

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5
Q

neurapraxia

A

-temporary nerve conduction blockage

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6
Q

erb’spalsy

A
  • most common (52%)
  • injury to C5 and C6 nerve roots
  • the child’s shoulder is held in extension, internal rotation and adduction, elbow extension, forearm pronation and the hand and fingers held in flexion

-paralysis of the rhomboids, levator, serratus, subscapularis, deltoid, infraspinatus, teres minor, biceps, brachialis, supinator, crachioradialis, nd finger and thumb extensors can be expected

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7
Q

Klumpke’s palsy

A
  • rare, usually from a breech delivery with the arm overhead
  • involvement of the lower nerve roots of C7-T1
  • child’s shoulder and elbow at enot impaired
  • however, the resting position of the forearm is in supination and elbow flexion, and there is paralysis of the wrist flexors and extensors, and intrinsic musclkes of the wrist and hand
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8
Q

erb-klumpke palsy

A

-combination of injury to the upper and lower nerve roots resulting in total arm paralysis and loss of sensation

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9
Q

horner’s syndrome

A
  • avulsion of T1 roots presenting as deficient sweating (anhidrosis), recession of the eyeball (miosis), decreased pupil size, partial (ptosis) drooping of the eyelid, and irises of different colors (rare)
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10
Q

impairments of OBPI

A
  • during period of neural regeneration, children often use substitutions such as medially rotated shoulder with forearm pronation and wrist flexion when grasping
  • may neglect impaired arm. can lead to contrcatures and abnormal bone growth

-positional torticollis can develop since heas is positioned away from involved arm

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11
Q

activity limiattions in OBPI

A
  • inability to reach, grasp and perform tasks requiring bilateral manual abilities. ADLs such as dressing
  • developmental delays or asymmetry
    neglect or self abusive behavior
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12
Q

physical therapy examination of OBPI

A
  • followed at weeks and at , and mo. if no recovery is evident an MRI may be performed te define nerve root integrity. may be referred to PT days, weeks, months or years after initial injury
  • ROM. involved arm and cervical area are compared to contralateral side. be cautious as joints may be unstable and have sensory loss
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13
Q

physical therapy examination of OBPI muscle strength and motor fucntion

A
  • palpate muscle contraction while testing tracking and primitive reflexes. asymmetry of abdominal and thoracic movement may indicate phrenic nerve paralysis.
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14
Q

sensory grading system for kids with BPI

A
  • S0 is no reaction to painful or other stimuli
  • S1 is reaction to painful stimuli,not touch
  • S2 is reaction to touch, not light touch
  • S3 is apparently normal sensation
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15
Q

active movement scale Gravity eliminated

A

GE

  • no contraction: 0
  • contraction, no motion : 1
  • motion less than or equal to 1/2 range : 2
  • motion greater than 1/2 range : 3
  • full motion : 4
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16
Q

active movement scale against gravity

A
  • motion less than or equal to 1/2 range : 5
  • motion greater than 1/2 range : 6
  • full motion : 7
17
Q

physical therapy goals

A
  • support spontaneous recovery and prevent secondary impairments of contractures and joint injury
  • increase ROM and strength throughout the first 2 years
  • goals will need to be revised if child loses range or plateaus for several months
  • full ROM is difficult to maintain when muscle imbalances still exist
  • age appropriate self care skill participation
18
Q

procedural intervnetions initially after birth

A
  • no ROM
  • limb is positioned across the abdomen
  • avoid lying on limb
19
Q

procedural interventions after rest period

A
  • Pt evaluation
  • HEP with ROM
  • parent education on risk of dislocation and sensory loss issues
  • strengthening activities through play
20
Q

procedural intervnetions active movement

A
  • facilitate normal movement patterns
  • inhibit substitutions during reaching and WB activities
  • eliminate gravity for weak muscles
  • hand to mouth, transferring objects, weight shift on propped UE and creeping
  • place infant in sidelying on uninvolved arm to free involved arm to work on reaching
  • pushing up to sitting from invpolved side
  • bilateral activities
21
Q

procedural intervention ROM

A
  • avoid over stretching unstable joint
  • do not pick child up under axilla
  • stretch scapulohumeral muscles
  • botox and casting to improve elbow extension
22
Q

procedural interventions- sensory awareness

A
  • can lead to neglect self mutilation
  • games to identify or find object with involved hand
  • play with various temperatures and textures
23
Q

procedural interventions - positioning and splinting

A
  • while sleeping arm can be placed in abduction, ER, elbow flexion and supination on a pillow
  • wrist splints to prevent contrcatures
  • constrains uninvolved arms for short periods of time
24
Q

achieving scapulohumeral mobility

A
  • typically develops between 3 to 6 months of age
  • elongation of musculature between humerus and scapula and humerus and rib cage occurs during transitions movements of supine to sidelying and supine to prone
25
Q

facilitating scapular-thoracic activity

A
  • stability for mid range reaching
  • active thoracic extension prevents excessive scapular winging
  • initially developed in prone play
  • as child develops endurance in spinal extension, reach can be added
26
Q

intervention increasing shoulder girdle and elbow strnegth

A
  • facilitation of movments in which the child uses the arms to push from one position to another
  • beginning around 5 mo of age
27
Q

intervention developing isolated elbow movements

A
  • hand to body play
  • manipulating toys in prone on elbow
  • activating and exploring toys
28
Q

intervention isolated control of the forearm and wrist

A
  • emerges around 5 months with prone on elbows play

- self feeding

29
Q

intervention facilitating hand function

A
  • weight shifting on extended arms helps to expand the hand so it will malleable enough to actively arch during grasp and manipulation
  • helping the child to grasp with the wrist in neutral will gaciliate and appropriate balance between flexion and extension over the wrist, through the palm and over the metacarpal joints
  • development of release requires the child to learn to use long finger exetnsors from a point of stability

Pediatrics (19 decks)

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