brachial plexues Flashcards
The brachial plexus consists
cervical c5-c8
thoracic T1
and variable C4 (pre-fixed) or T2 (post-fixed) contributions.
in BP there are 5 roots and 3 trunks
true or false?
true
what are the trunks of BP?
superior
middle
inferior
the BP goes as roots, trunks,divisions,cords ,and branches
true or false?
true
what is the reason for obstetric brachial plexus injury?
traction to the brachial plexus during labor
what are the results of OBPI?
flaccid paralysis of the arm
muscle weakness, atrophy and contractures, inability to load weight on the affected arm, sensory disturbances,and growth retardation
C7 had the shortest root and T1 had the longest root length.
true or false?
false, its the opposite
Nerves with short spinal root lengths are more prone to deformation due to longitudinal traction
true or false?
true
C5 and T1 nerve roots are more difficuilt injured by traction maneuver
true or false?
false, more easily
what are the etiology of OBPI?
Shoulder dystocia
fetal size of more than 4000g
comorbid birth trauma
gestational diabetes leading to macrosomia
second stage of delivery (<15mins) and vacuum birth
OBPI is more often encountered in overweight mothers (BMI>29) and those aged over 35 years
true or false?
true
There is a higher incidence of OBPI in cesarean than in vaginal birth
true or false?
false
breech birth is a risk factor OBPI
true or false?
true
The most common finding accompanying OBPI is humeral fracture
true or false?
false clavicular fracture
There is difference in gender of the new borns with OBPI
true or false?
false
what are the common injured roots nerve when the shoulder is squeezed because of excessive pulling during labor?
c5-c6 and upper trunk
what are the injured roots nerve related to breech labor?
C8-T1 roots and lower trunk
how can the BPI happen during normal birth?
develops after traction applied to the nerves with excessive lateral bending of the head and neck during the outflow of the shoulders
what are the types of nerve injuries?
neuropraxia
axontonmesis
neurotmesis
what is the blockage of conduction called?
neuropraxia
what is called when the axon not continues but the nerve is intact?
axontonmesis
rupture of the nerve is neurotmesis
true or false?
true
Wallerian degeneration takes place in axontonmesis but not in neuropraxia
true or false?
true
Upper Brachial Plexus Lesions (Erb-Duchenne) Injury in C5-6 (±C7).
true or false?
true
UBPL is common during head presentation labor?
true or false?
true
paralysis of UBPI to which muscles?
biceps, deltoid, brachioradialis, infra and supraspinatus, brachialis, rhomboid and teres minör muscles abduction and external rotation of the arm are lost, forearm flexion and supination weaken
sensory impairments are to which muscles in UBP?
deltoid and radial forearm
what are the lost reflex in UBPI?
biceps,moro,radial
Lower Brachial Plexus Lesions (Klumpke) the affected nerves are?
c8-t1
klumpke characterized by paralysis and atrophy of the small muscles of the hand, the claw hand occurs, sensory impairment is in the ulnar part of the hand
true or false?
true
Skin edema, cyanosis, trophic nail changes may occur in?
lower brachial plexus injuries
Forearm flexor muscles, hand intrinsic muscles, finger extensors and wrist flexor muscles are not affected in LBPI
true or false?
false, are affected
Sensory defect is seen in the medial of the forearm in LBPI
true or false?
true
which reflex is lost in LBPI?
grasp reflex
horner syndrom can be seen in UBPI
true or false?
false, LBPI
horner syndrome happens because of the parasympathetic fibers injury of T1
true or false?
false, sympathetic fibers of T1
Miosis
Ptosis
Enophthalmos
Anhidrosis
are all related to?
horner syndrome
neglect of the arm happens in ?
total BP injury
winging scapula is related to which nerve roots?
c5-c6
torticollis should be evaluated to any OBPI
true or false?
true
phrenic nerve involvement related to ?
respiratory
primitive reflexes are used to evaluate motor function
true or false?
true
Mallet Classification that is most commonly used to?
OBPI
what is the ability to recognize letters and numbers written on certain parts of the body with a blunt object?
Grafesthesia
grafesthesia is measured form age 5
and 2 pont tactil descrimination mesured from age 9
ture or false?
true
grafesthesia is measured from age 5
and 2 pont tactil descrimination mesured from age 9
True or false?
True
how can we evaluate deep sensations?
Semmens-Weinstein monofilament test
EMG should be taken after the 20th day for OBPI
true or false?
false, t0th
1-Swinging the arm next to the body should be prevented.
2-The baby should be held under the belly.
3-The arm should be kept at the level of the baby’s neck.
4-Shoulder and elbow should be checked continuously for subluxation
which are wrong?
2nd and 3rd
what are the purposes of PT in BPI
Protecting ROM
Prevent contractures
Prevent asymmetry
To provide sense-motor integration
Facilitate reflex development (protective extension)
Guiding activities involving bilateral limb movements
passive movements should be started in the first week
and ABD+elevation of shoulder should not exceed 90 degress in the first 3 weeks
true or false?
true
Weight transfer exercises must be done to prevent the difference in arm length in the developing child
true or false?
true
Reducing contracture
To prevent the development of deformity
Supporting movement
are done by?
splints
what is the rehabilitation for phase one?
in the first 2 weeks, the caregiver should be informed about the positioning, holding and daily life
Weight transfer exercises to prevent muscle tension, increase ROM, sensory and muscle strength, provide proprioceptive stimulation and isometric muscle contraction
are done in which rehab stage?
2nd phase 2 weeks-4 months
Providing age-appropriate skills, rolling-turning, protective reactions, and reaching out. Preventing contractures and deformities
are done in which rehab phase?
3rd phase 4-6 months
Phase 4 (6-12 months)
is about Increasing muscle strength and sensation, promoting sitting, crawling, standing, walking. Prevention of contractures and deformities, revealing functional movement with electrical stimulation (Russian Current-NMES).
true or false?
true
what is Phase 5 (1-4 year)
in rehb?
Acquiring age-appropriate skills, preventing learned use, preventing contracture and deformity, hydrotherapy
phase one =first 2 weeks
phase 2= 2 weeks-4 months
phase 3= 4- 6 months
phase 4= 6-1 year
phase 5= 1-4years
true or false?
true
when the preventing physiotherapy or immobilization position is applied?
1st 3 weeks
Supine Positioning
-A roll should be placed under the head, neck, shoulders and elbows
true or false?
true
To prevent head and neck extension
-To prevent excessive retraction of the shoulder
-To prevent excessive extension of the arm
-Supporting bilateral active movements
are achieved in ?
supine positioning
A roll under the head, thoracic and lumbar areas should be supported with a roll, and a roll between the arms to reach under the elbow
to which position is this?
sidelyine
what is the aim of side-lying positoining?
To provide the aid of gravity to active arm movement.
To provide active mobilization of the scapula
how prone position is applied?
a roll under the chest
Facilitation of bilateral weight transfer to forearms and hands with head control
is the aim of?
prone position
how can we provide sensory inputs?
-Classic massage
-Weight transfer in the prone position and in the crawling position
-Stimulating the affected side with different surfaces and brushes
2-3 weeks later
for?
PROM
Shoulder flexion 90
Shoulder abduction 140
for PROM
ture or false?
false, flex=140
ABD= 90
5 seconds should wait at the end of the movement for PROM
true or false?
true
3-4 times a day, 20 repetitions for PROM
true or false?
false, 10 repetitons
Early protection
Exercise
Electrical stimulation
Splinting
Scar treatment
Desensitization
Family Education
Periodic evaluation
are for?
early rehabilitation surgery
before 6 month is PROM
and after is AROM
true or false?
true
electrical stimulation is applied during?
4weeks-3 months
weight bearing and strengthening exercises when are applied?
more than 6 months
immobilization splint are applied in?
0-3 weeks
sensory education is done after?
4th month
0-6 weeks: Immobilization
6-8 weeks: Exercise without the gravity, Electric stim.
8-10: weeks: Night use of the splint. Mild strengthening exercise, mild functional exercise
12 weeks: Stretching exercise,Functional exercise
is program for?
rehabilitation after tendon transfer
what type of assessments should be done for BPI?
motor functional
physical
respiratory
tonus
sensory
UE length and circumference
volume
scolioses
balance
EMG