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becky: PEDIATRICS > EXAM 3: brachial plexus > Flashcards

EXAM 3: brachial plexus Flashcards

1
Q

median nerve distal branch is most well represented nerve of the brachial plexus T or F

A

True

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2
Q

CNS is composed of the _ part of the SC

A

posterior (dorsal) horn

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3
Q

PNS is composed of the
_
_
_
_

A

-dorsal root/rootlets
-dorsal root ganglion
-ventral horn/roots/rootlets
-spinal nerves

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4
Q

BP anatomy

MCN comes off the _ cord
axillary comes off the
radial nerve comes off the _ cord
median nerve comes off the _ and _ cord
ulnar nerve comes off the _

A

MCN C5-7: lateral cord
axillary C5,6: posterior cord
radial C5-T1: posterior cord
median C5-T1: lateral and medial cord
ulnar C8, T1: medial cord

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5
Q

BP anatomy

Brachial Plexus:
how many roots, trunks, divisions, cords, branches?

A

5 Roots C5-T1 ventral rami
3 trunks: C5,6; C7; C8, T1
3 anterior and 3 posterior divisions
3 cords: lateral, posterior, medial cords
5 branches MARMU

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6
Q

dorsal scapular nerve: comes from nerve roots _
long thoracic nerve: comes from which nerve roots

A

dorsal scapular nerve: C5 nerve root
long thoracic nerve: C5, C6, C7

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7
Q

borders of the brachial plexus

A

anterior scalene
middle scalene
subclavian artery

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8
Q

upper trunk gives rise to which C5, C6 nerve?

A

upper trunk: suprascapular nerve C5,6 for supraspinatus and infraspinatus

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9
Q

anterior division of the BP innervates _
posterior division of the BP innervates _

A

anterior: flexors (and hand intrinsics)
posterior: extensors

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10
Q

BP anatomy

Which nerves come directly off the lateral cord?
medial cord?
posterior cord?

A

lateral cord:
-lateral pectoral nerve C5-7: for PEC MAJOR

medial cord:
-medial pectoral nerve: pec major and minor
-medial cutaneous of arm
-medial cutaneous of forearm

posterior cord:
-lower subscap nerve:
-lower subscap nerve:
-thoracodorsal nerve: lat! C6-8

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11
Q

peripheral nerves regrow at what rate

A

1 inch per month
*schwann cells allow peripheral nerve to regenerate

major education point for families after BP surgery

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12
Q

which recovers faster, transfers or grafts for nerves?

A

transfers: faster recovery, less fibers
grafting: slower recovery, more fibers

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13
Q

motor endplates: are these important?

A

Yes! where nerve talks to muscle
muscles go away without innervation
big dumb mm degrade slower
small smart mm degrade faster

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14
Q

long bone growth during growth spurts cause problems like

A

contractures

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15
Q

If glenoid is not doing well, you are gonna lose

A

passive motion like ER

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16
Q

remodeling potential of the Glenohumeral joint decreases at _ years of age

A

4 years

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17
Q

history: what do you want to know

A
  • pregnancy
  • delivery
  • gestational age and weight (bigger = risk)
  • fx
  • breathing/feeding
  • arm presentation
  • timeline
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18
Q

maternal risk factors for BP injury in baby

A
  1. AMA (over 35)
  2. pelvic anatomy
  3. high BMI
  4. infections
  5. gestational diabetes
  6. primiparity
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19
Q

risk factors for BP injury of baby during delivery

A
  1. high birth weight
  2. breech
  3. sholder dystocia
  4. clavicle fx
  5. used forceps/vacuum to deliver
  6. previous BP injuries with other births
20
Q

brachial plexus injuries are _ every 1000 births

21
Q

for baby clavicles, fractures heal in _ days
immobilize for _ days

A

21 days
immob: 14 days

see kids at 3-4 week mark

22
Q

for baby humeral fx, mostly heal in _ weeks
immobilize for _ weeks

A

heal in 6 weeks
immob for 4 weeks

23
Q

If C7 is present, they will have

A

elbow extension

24
Q

C 5-T1 + horners

A

shoulder ER
supination
drooping eyelid

25
C5, 6, 7 may skip what milestone?
crawling among other stuff
26
how to test sensation in under 3 years?
If they pause attention and look or pain response *pinch in median, radial, ulnar distribution
27
If shoulder is internally rotated due to BP injury, what can happen at the GH joint?
developmental dislocation posteriorly
28
If you have an avulsion injury, nerve root pulling out of spinal cord, what will you see?
CSF fill in, bright white on MRI will not get better
29
If child is younger than 8-9 months old and not responding to conservative treatment? What can you do?
botox to IRs, cast for 6 weeks in ER go back into HERO strap
30
9 months is the last stop for decision making: why
*MOTOR END PLATES *mm are degenerating at 9 months.
31
what age do majority of kids dislocate?
3-6 months 60-80% of infants with motor deficits beyond 3 – 6 mos. develop dysplasia * 30% of infants dislocate in the first year of life
32
what asymmetries to look for with BP eval?
1. head shape 2. gaze preference 3. torticollis 4. eyelids/pupils 5. chest rise
33
horner's sign is what 3 things? indicates a _ nerve root avulsion
1. ptosis (drooping eyelid) 2. myosis (constricted pupil) 3. anhidrosis of face (no sweat) T1 nerve root
34
T or F: torticollis is related to severity of brachial plexus injury T or F: torticollis affects probability of BP recovery
FALSE for both but it is present in 43% (about half) of BP injury patients
35
plagiocephaly cannot be effectively treated after _ months of age
9 months *think about fontanelles
36
AMS is what?
activity movement scale for 0-8 year olds scale grades 0 to 7 (7 is full against gravity)
37
If the shoulder flexion is occurring only with shoulder IR and horizontal ADD... what mm is compensating?
PEC MAJOR
38
If in supine, patient lifts arm off table during abduction, they are subbing with what mm
pec major
39
* Shoulder stays mostly **ADD ucted** * Whole arm is off the mat * Cubital fossa pointing at his body** (shoulder IR)** *** No active shoulder abduction** what mm is active? what mm is not working?
no delt (C5) pec major is subbing
40
In supine, an infant has unopposed internal rotators and when they ”relax” it appears they have external rotation. What is not working?
C5
41
What is the AHA?
assisting hand assessment
42
When is an ultrasound recommended to be ordered?
when ER/adduction is less than 60 degrees *30% of patients with BPI had posterior dislocation in 1st year of life
43
What are non surgical options for BP injuries? They are 6 months old, have a posterior humeral head dislocation even after PT...
Botox to IR cast in ER followed by HERO strap
44
What are surgical options for a BP injury?
neurolysis: separate adhesions accompanied by --> grafting (often sural nerve) OR transfer
45
Schwann cells allow only peripheral nerves to regenerate bc they contain
nerve growth factor *nerve regrowth is a MAJOR LIMITING FACTOR for BP injury
46
True or F: use EMG/NCS for infants
false assists with surgical planning for older child being considered for a 2nd tendon transfer Sx
47
What are 3 secondary ortho surgeries for BPI?
1. anterior release 2. humeral derotational osteotomy 3. lat transfer

becky: PEDIATRICS (30 decks)

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