M1.4 — 6 radiculopathies and plexopathies

Question 1

where is the fulcrum of neck movement in <8yo, 8-12 yo, >12yo

Answer 1

<8yo = C1 and C3
8-12yo = C3 and C5
>12 yo = C5 and C6

Question 2

how are C1, C2 and C3 facets angled during first year?

Answer 2

horizontal = greater tendency to anterior translation. This with ligament laxity and muscle strength less = increased risk for spinal cord injury

Question 3

cervical radiculopathy presentation in adolescents is not always typical with neck pain, shoulder and arm pain. What is?

Answer 3

weakness and atrophy of the arm may predominate

Question 4

what is a typical pattern of presentation of cervical radiculopathy in kids?

Answer 4

• pain precedes numbness by 4-8 weeks
• temporary improvement
• paresthesia and motor loss a few weeks laters
• intermittent numbness in shoulder, scapula, arm

Question 5

what is the imaging of choice for cervical radiculopathy?

Answer 5

MRI

Question 6

What are symptoms of congenital cervical stenosis in children?

Answer 6

• neck P
• progressive painless arm weakness
• spamming in cx paraspinal muscles

Question 7

What is Klippel-Feil syndrome? signs?

Answer 7

• bony fusion between 2 or more vertebrae
• characteristic short neck
• limited Cx and shoulder ROM
• HA, neck pain
• Sprengel deformity common (one or both scapula abnormally positioned)
• scoliosis
• predisposes for radiculopathy

Question 8

what is Hirayama’s disease?

Answer 8

cervical spinal muscular atrophy
- progressive weakness and atrophy of the hand and forearm
- primarily young males

Question 9

What are radiculopathy signs of ALS?

Answer 9

• painless weakness of upper extremity
• lower motor neuron signs
• eventually flaccid arms
• insidious progressive disorder leads to early death

Question 10

Newborns can have a brachial plexus injury which is not uncommon due to what 3 possibilities? Which roots are most commonly affected

Answer 10

• traumatic birth
• instrument assisted delivery
• suboptimal positioning inutero

C5-6

Question 11

What are risk factors for obstetrical complications leading to plexus injury?

Answer 11

• macrosomnia: size at birth >8.8lbs, especially >9.92 lbs
• disproportion mother/fetus: small pelvis
• shoulder dystocia
• gestational diabetes
• pre-eclampsia, hypertension
• multiparity
• prolonged labor
• breech delivery
• previous complication

Question 12

what are postnatal signs of plexus injury?

Answer 12

• respiratory difficulties
• evidence of fracture (clavicle)
• shoulder dislocation
• possible Horner’s syndrome (miosis, ptsosis, anhidrosis)
• extent of infant paralysis
• acute onset of flaccid arm is more typical of infection

Question 13

What are signs of a neoplasm causing brachial plexopathy

Answer 13

• onset of weakness after first postpartum day
• progressive course
• hx of normal delivery and birth weight
• mass in supraclavicular region without clavicle fracture
• scratch marks on weak arm

Question 14

what are signs of osteomyelitis causing brachial plexopathy?

Answer 14

• fever
• elevated ESR
• streptococcal sepsis
• Ev positive bone scan

Question 15

What are 3 possibly causes of non hereditary pressure palsies?

Answer 15

• uncommon but risk with prolonged sitting in car seats
• heavy knapsacks
• rule out child abuse in young child

Question 16

where does the dorsal scapular nerve arise? what does it innervate? prognosis of denervation?

Answer 16

• C5
• rhomboid
• poor prognosis

Question 17

where does the long thoracic nerve arise? what does it innervate? prognosis of denervation?

Answer 17

• C5, C6, C7
• serratus anterior
• scapular winging

Question 18

where does the suprascapular nerve innervate? prognosis of denervation?

Answer 18

supra- and infraspinatus

Question 19

what is the origin of the lateral cord? what nerves does it supply?

Answer 19

C5-6
- musculocutaneous nerve (biceps brachii, brachialis)
- lateral head of median nerve (pronator teres, forearm flexors, pectoralis major) rl

Question 20

what is the origin of the posterior cord? what nerves does it supply?

Answer 20

C6-7
- subscapular nerve (subscapularis)
- thoracodorsal nerve (lat dorsi)
- axillary nerve (deltoid, teres major)
- radial nerve (triceps, wrist and finger extensors)

Question 21

what is the origin of the medial cord? what nerves does it supply?

Answer 21

C8-T1
- medial head of median nerve (flexor pollicus longus, thenar intrinsic hand)
- ulnar nerve (hypothenar intrinsic hand)
- medial pectoral nerve
- medial brachial nerve
- medial antebrachial cutaneous nerve

Question 22

how common are primary birth related brachial plexus lesions?

Answer 22

2/1000 births

Question 23

what are symptoms of TOS?

Answer 23

hand weakness, atrophy or both, may be painful

Question 24

what is Erb’s Palsy?

Answer 24

• injury to the upper brachial plexus (C5-6)
• “Waiter tip” deformity of wrist
• “bird-winging scapula”
• ptsosis, miosis
• forward-rotated shoulder
• upper arm redness, muscle atrophy and diminished arm length

Question 25

what factors associated with unfavorable prognosis of plexus injury?

Answer 25

- lower plexus lesions & Horner’s syndrome - total plexus involvement with no improvement in first week - absence of appreciable recovery by 6 months - phrenic nerve palsy - avulsion of ventral or dorsal nerve rootlets from spinal cord with preganglionic nerve root injury

Question 26

what is the primary goal of manual therapy with brachial plexus injury?

Answer 26

prevent joint contractures