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Pediatric PT > BPI and juvenile idiopathic arthritis > Flashcards

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
Q

What are secondary diagnoses/considerations for BPI?

A
  • compensation with other muscles
  • neglect the extremity
  • contractures
  • abnormal bone development
  • torticollis
  • Horner’s syndrome
  • damage to the phrenic nerve

Contractures:
Scapular protraction
shoulder ABD, EXT, and IR
PRON
Wrist and finger FLX

26
Q

What are the primary activity limitations with BPI?

A
  • reaching
  • grasping
  • bilateral manipulation
27
Q

What developmental screening tools would you use for children with BPI?

A

TIMP
AIMS (< 4 months)

28
Q

What are rehab goals for children with BPI?

A
  • support spontaneous recovery
  • minimize pain
  • prevent secondary impairments
  • promote typical movement patterns and development
  • increase PROM, strength, sensory awareness, and self-care
29
Q

What is the prognosis of BPI?

A

3-25% chance of FULL recovery

30
Q

How is prognosis determined in BPI cases?

A

Indicators within the first few weeks

Complete recovery is unlikely if no improvement is seen within the first 2 weeks

31
Q

(true/false) Neurosurgery is useful for restoring full function in BPI cases

A

FALSE

Just some function

32
Q

When does neurosurgery for BPI have the best outcome?

A

If done between 3-8 months

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
Q

What are indications for neurosurgery in BPI patients?

A
  • limited recovery
  • lack of shoulder ER and forearm SUP
34
Q

What is neurosurgery for BPI typically followed-up with?

A

Immobilization for 3 weeks and then PROM and AROM

35
Q

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

A

16 y/o

36
Q

(true/false) There are definitive tests for diagnosis of JIA

A

FALSE

only clinical Dx and exclusion of other possible Dx

37
Q

What must you rule out for a Dx of JIA?

A
  • joint infection
  • rheumatic diseases
  • trauma
  • malignancies
  • systemic illnesses
  • toxic synovitis
38
Q

Once all other possible Dx are ruled out, JIA symptoms must persist for _ weeks before Dx

A

6 weeks

39
Q

What must the patient present with for JIA dx?

A

arthritis
AND 2+ of the following:
- heat
- ROM limitations
- TTP with motion

40
Q

What are the categories of JIA? Which one is more common?

A
  1. oligoarthritis*
  2. Rheumatoid-factor- positive polyarthritis
  3. Rheumatoid-factor-negative polyarthritis
  4. Systemic disease

RF(-) polyarthritis is more common than RF(+) polyarthritis

41
Q

Oligoarthritis is common in what population?

A

Girls 2-4 y/o

42
Q

How many joints are inflammed with oligoarthritis?

A

< 4

Common invovement: elbow, knee, ankle

43
Q

What form of JIA develops iridocyclitis?

A

oligoarthritis

Iridocyclitis: inflammation of the iris

30% of cases and may be asymptomatic

44
Q

(true/false) Those with oligoarthritis typically have systemic signs

A

FALSE

45
Q

When does RF(+) polyarthritis present itself?

A

Peaks at 2-4 y/o and then again at 6-12 y/o

46
Q

When does RF(-) polyarthritis present itself?

A

Late childhood or adolescence

47
Q

How many joints does polyarthritis affect?

A

5+

Common joint involvement: TMJ, Cx spine, Elbows, Wrists, Knees, ankles

48
Q

Polyarthritis presents with (mild/severe) systemic signs

A

mild

49
Q

When does joint involvement occur with Systemic JIA?

A

After systemic onset

50
Q

What are signs of possible systemic JIA?

A
  • hepatosplenomegaly
  • lymphadenopathy
  • pleuritis
  • pericarditis

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
Q

What is required for systemic JIA?

A
  • fever spikes 2x/day with return of normal for 2 weeks
  • Rash
  • joint involvement after systemic onset
52
Q

What is the etiology of JIA?

A

unknown

considerations/theories: autoimmune, infection, trauma, genetics

53
Q

What medications are used for medical management of JIA?

A
  1. NSAIDS
  2. DMARD
  3. glucocorticoids

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
Q

What JIA factors cause poor articular and functional outcomes?

A
  • hip involvement
  • Polyarthritis w/in first year of disease
55
Q

What form of JIA has the best prognosis for joint preservation and function?

A

Oligoarthritis

56
Q

What are those with oligoarthritis at risk of forming?

A
  • contractures
  • degenerative arthritis
57
Q

(True/false) RF(+) polyarthritis has good functional outcome

A

FALSE (persistent diesase)

58
Q

Hip disease occurs in -% of those with JIA

A

30-50%

Signs:
- LLD
- pain in the groin, buttocks, medial thigh, knee
- gluteus medius limp (trendelenburg)

59
Q

Hip disease of JIA is commonly caused by what?

A

Compensation for hip FLX contractures and increased lumbar lordosis

Pediatric PT (14 decks)

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