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BPI and juvenile idiopathic arthritis Flashcards

1
Q

The incidence rate of BPI (decreases/increases) with a c-section

A

decrease

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2
Q

What are the etiologies of BPI?

A
  • traction and ROT of the head (injury to C5 -C6)
  • congenital anomaly (cervical rib or abnormal thoracic vertebrae)
  • traction of the shoulder
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3
Q

What are risk factors for BPI?

A
  • maternal diabetes
  • high birth weight (greater than 90th percentile)
  • prolonged labor
  • sedation
  • shoulder dystocia
  • Breech delivery
  • complex c-section
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4
Q

Neurotmesis is a ____ rupture of a portion of the brachial plexus.

A

complete rupture

Has limited recovery; complete functional loss of affected nerve

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5
Q

What is axonotmesis?

A

Disruption of the inner elements of the brachial plexus

Has improved recovery compared to neurotmesis; gradual recovery

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6
Q

What is the mildest form of traumatic peripheral nerve injury?

A

Neurapraxia

Commonly has a full recovery; recovers as edema resolves

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7
Q

Brachial plexus injuries can hemmorhage into the ____ space.

A

subarachnoid space

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8
Q

Axons regrow by _ mm/day

A

1 mm

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9
Q

Recovery to the axons in the Upper arm normally takes how long?

A

4-6 months

can continue for up to 2 years

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10
Q

Recovery to the axons in the lower arm normally takes how long?

A

7-9 months

may continue for up to 4 years

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11
Q

What percentage of brachial plexus injuries do not fully recover?

A

approx. 35%

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12
Q

What is the most common brachial plexus injury? What nerve roots does it involve?

A

Erb’s Palsy (C5-C6)

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13
Q

What is observed within the UE when Erb’s palsy is present?

A

Shoulder: ADD, IR, EXT
Elbow: EXT
Forearm: PRON
Wrist/finger FLX

  • Waiter’s tip position
  • sensory loss
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14
Q

(true/false) Grasp is not intact if Erb’s Palsy is present

A

FALSE (it is present)

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15
Q

(true/false) Klumpke’s Palsy is common.

A

False

Rare condition that is only 2% of cases

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16
Q

What Nerve roots does nerve palsy include?

A

C7-T1

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17
Q

What is the presentation of Klumpke’s palsy?

A
  • SUP
  • Paralysis of wrist mm and intrinsic muscle of the hand
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18
Q

What is Erb-Klumpke Palsy?

A

Complete brachial plexus injury (C5-T1)

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19
Q

What is the presentation of Erb-Klumpke’s palsy?

A
  • lack of sensation
  • absent DTRs
  • Asymmetric MORO response
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20
Q

Erb-Klumpke’s Palsy is typically (unilateral/bilateral) paralysis of an extremity

A

Unilateral paralysis

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21
Q

What is Horner’s syndrome?

A

Avulsion of T1 nerve

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22
Q

What can Horner’s syndrome result in?

A
  • deficient sweating
  • recession of eyeball(s)
  • abnormal pupillary response
  • myosis
  • ptosis
  • different color iris

myosis: reflex contraction of the sphincter muscle of the iris in response to a bright light (or certain drugs) causing the pupil to become smaller

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23
Q

What does damage to the phrenic nerve at C4 cause?

A

ipsilateral hemiparesis of the diaphragm

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24
Q

What is the presentation of a BPI affecting the phrenic nerve?

A

Presents as respiratory distress with an elevated chest on one side

25
What are secondary diagnoses/considerations for BPI?
- compensation with other muscles - neglect the extremity - contractures - abnormal bone development - torticollis - Horner's syndrome - damage to the phrenic nerve ## Footnote Contractures: Scapular protraction shoulder ABD, EXT, and IR PRON Wrist and finger FLX
26
What are the primary activity limitations with BPI?
- reaching - grasping - bilateral manipulation
27
What developmental screening tools would you use for children with BPI?
TIMP AIMS (< 4 months)
28
What are rehab goals for children with BPI?
- support spontaneous recovery - minimize pain - prevent secondary impairments - promote typical movement patterns and development - increase PROM, strength, sensory awareness, and self-care
29
What is the prognosis of BPI?
3-25% chance of FULL recovery
30
How is prognosis determined in BPI cases?
Indicators within the first few weeks ## Footnote Complete recovery is unlikely if no improvement is seen within the first 2 weeks
31
(true/false) Neurosurgery is useful for restoring full function in BPI cases
FALSE | Just some function
32
When does neurosurgery for BPI have the best outcome?
If done between 3-8 months ## Footnote Surgeries to treat complete paralysis (Erb-Klumpke's Palsy) should be done by 3 months --> has better outcomes than adults --> improved outcome in infants with total palsy
33
What are indications for neurosurgery in BPI patients?
- limited recovery - lack of shoulder ER and forearm SUP
34
What is neurosurgery for BPI typically followed-up with?
Immobilization for 3 weeks and then PROM and AROM
35
JIA is a term that encompasses all forms of arthritis that begin before the age of ____ years, persist for longer than 6 weeks, and are of unknown cause
16 y/o
36
(true/false) There are definitive tests for diagnosis of JIA
FALSE | only clinical Dx and exclusion of other possible Dx
37
What must you rule out for a Dx of JIA?
- joint infection - rheumatic diseases - trauma - malignancies - systemic illnesses - toxic synovitis
38
Once all other possible Dx are ruled out, JIA symptoms must persist for _ weeks before Dx
6 weeks
39
What must the patient present with for JIA dx?
arthritis **AND** 2+ of the following: - heat - ROM limitations - TTP with motion
40
What are the categories of JIA? Which one is more common?
1. oligoarthritis* 2. Rheumatoid-factor- positive polyarthritis 3. Rheumatoid-factor-negative polyarthritis 4. Systemic disease ## Footnote RF(-) polyarthritis is more common than RF(+) polyarthritis
41
Oligoarthritis is common in what population?
Girls 2-4 y/o
42
How many joints are inflammed with oligoarthritis?
< 4 | Common invovement: elbow, knee, ankle
43
What form of JIA develops iridocyclitis?
oligoarthritis | Iridocyclitis: inflammation of the iris ## Footnote 30% of cases and may be asymptomatic
44
(true/false) Those with oligoarthritis typically have systemic signs
FALSE
45
When does RF(+) polyarthritis present itself?
Peaks at 2-4 y/o and then again at 6-12 y/o
46
When does RF(-) polyarthritis present itself?
Late childhood or adolescence
47
How many joints does polyarthritis affect?
5+ ## Footnote Common joint involvement: TMJ, Cx spine, Elbows, Wrists, Knees, ankles
48
Polyarthritis presents with (mild/severe) systemic signs
mild
49
When does joint involvement occur with Systemic JIA?
After systemic onset
50
What are signs of possible systemic JIA?
- hepatosplenomegaly - lymphadenopathy - pleuritis - pericarditis ## Footnote Hepatosplenomegaly: enlargement of liver and spleen Lymphadenopathy: swelling of the lymph nodes pleuritis: inflammation of lung lining pericarditis: inflammation of sac around the heart
51
What is required for systemic JIA?
- fever spikes 2x/day with return of normal for 2 weeks - Rash - joint involvement after systemic onset
52
What is the etiology of JIA?
unknown ## Footnote considerations/theories: autoimmune, infection, trauma, genetics
53
What medications are used for medical management of JIA?
1. NSAIDS 2. DMARD 3. glucocorticoids ## Footnote methotrexate (DMARD) is the most common disease modifying agent -- must monitor liver enzymes for possible toxicity Glucocorticoids are potent and effective anti-inflamatories -- side effects consist of cushing's syndrome and growth retardation
54
What JIA factors cause poor articular and functional outcomes?
- hip involvement - Polyarthritis w/in first year of disease
55
What form of JIA has the best prognosis for joint preservation and function?
Oligoarthritis
56
What are those with oligoarthritis at risk of forming?
- contractures - degenerative arthritis
57
(True/false) RF(+) polyarthritis has good functional outcome
FALSE (persistent diesase)
58
Hip disease occurs in -% of those with JIA
30-50% ## Footnote Signs: - LLD - pain in the groin, buttocks, medial thigh, knee - gluteus medius limp (trendelenburg)
59
Hip disease of JIA is commonly caused by what?
Compensation for hip FLX contractures and increased lumbar lordosis

Pediatric PT (14 decks)

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