11/11 Peds Brachial Plexus Injury Flashcards
What roots of the brachial plexus are commonly injured during a brachial plexus injury?
C5 and C6 roots
C4 and C7 damage is rare
What causes brachial plexus injury infants?
If the baby is too big for the vaginal canal during a
Vaginal delivery - could result in forceful traction/rotation of the head/ shoulder due to breech delivery.
If the clavical/humerus is fractured upon delivery
If the baby has short scalene muscles due to packaging problems
What are the 4 kinds of neuronal injury?
- Neurontomesis- complete rupture
- Axontomesis - intact neural sheath- disrupt axons
- Neuropraxia- temporary nerve conduction block
- Neuronal- fibrous tissue mass
What is Erbs Palsey?
Injury to the C5/C6 nerve root that occurs when the fetus’ head is SB away and the shoulder is depressed (stretches the upper levels of the brachial plexus)
What positioning of the UE will be present with Erbs palsey?
Humeral IR, EXT, ADD Elbow EXT Forearm Pronation Wrist and Finger FLEX (Waiters tip position)
T/F - A baby with Erbs palsey will present with hypertonia, hyper reflexia and will have LE involvement
FALSE- they will present with low tone, flaccidity, with no LE involvement
What other loss is commonly present in Erbs palsey?
Sensation can commonly be affected - big deal for babies and their interaction with the environment
What muscles are affected with Erbs palsey?
- Rhomboids, Levator Scap, Serratus, subscap, supraspin, infraspin, teres minor
- Biceps brachii, brachialis, brachioradialis
- Supinator
- Long extensors of wrist and fingers
What is affected in Erb-Klumpke Palsey?
Injury of C5-T1 -
Flaccid arm due to total paralysis - all muscles of the UE are involved
Sensory loss is possible
What is Klumpke’s Palsey? What position will they present in?
Injury of C7-T1
- Forearm supination, weak/flaccid hand and wrist
Muscles: pronator teres, wrist and finger flexors/extensors, wrist/ hand intrinsics
What compensatory strategies will a baby use when they have brachial plexus damage?
They will take the path of LEAST resistance and use the muscles that they have most innervated- will neglect the affected side
T/F - a brachial plexus injury can result in alterations to the spine as low as the pelvis
True!
What gross motor limitations will most likely be present in the child when they are in prone? Sitting/standing?
Prone limitations:
- prone on hands/elbows and reaching
- getting onto hands and knees
- creeping/crawling normally on all 4s
Sitting/Standing
- protective reactions
- reaching
- cruising/ bridging
What other functional/ Activity limitations would be present that could severely impact the child?
Being able to transition - rolling, sitting, pull to stand
Fine motor- playing, grasping, manipulating objects
Self care activities- feed and dress them selves
What should be included in the PT examination of this child?
- ROM of every joint in the UE
- Muscle strength and function
- Reflexes
- Sensation
- Mallet’s Classification- Grade I - no movement, Grade V- full movement of UE
- Functional limitations - PDMS II
