Brachial Plexus

Question 1

Brachial plexus is responsible for:

Answer 1

The motor innervation to upper limb, except trapezius and levator scapula The sensory innervation of the upper limp except an area just above the point of the shoulder

Question 2

What make brachial plexus?

Answer 2

Roots, trunks, divisions, cords, and terminal branches (muslculo-cutaneous n., ulnar n., median n., axillary n., radial n.

Question 3

what is a brachial plexus injury?

Answer 3

Brachial plexus injury is an injury to the network of nerves that send signals from the spine to the shoulder, arm, and hand.

Question 4

What are the two ways an injury occurs?

Answer 4

When nerves are stretched, or in more serious cases they are torn (avulsion)
When the shoulder is being pressed down forcefully while the head is pushed up and away from the shoulder

Question 5

What is happens in avulsion?

Answer 5

the nerve root is torn from the spinal cord

Question 6

common activities/ events that injury to the brachial plexus occurs:

Answer 6

Falls, contact sports, MVA, during birth, or inflammation or tumors

Question 7

General symptoms:

Answer 7

•Weakness, disability, burners and stingers, weakness in hand or arm, neck pain

Question 8

Symptoms for less severe injuries:

Answer 8

Less-severe injuries: Electric shock or burning sensation down arm, shooting down arm, lasts seconds or minuets, numbness or weakness

Question 9

Symptoms for more severe injuries:

Answer 9

•More-severe injuries: Tear or rupturing of nerves

Question 10

True or False: No damage occurs to the lower nerves when the shoulder is forced down, and the neck stretches up and away from the injured shoulder.

Answer 10

FALSE: upper nervesDamage to the upper nerves if the shoulder is forced down, and the neck stretches up and away from the injured shoulder

Question 11

True or False: Damage occurs to the lower nerves if an arm is forced above the head.

Answer 11

TRUEDamage to lower nerves if arm is forced above the head

Question 12

What are common complications with the injury?

Answer 12

muscle atrophy, pain, stiff joints, loss of feeling (there are more, reference notes to see the rest)

Question 13

True or False: It is important to be mindful of the patient’s pain when conducting session.

Answer 13

True: this will also help you build trust with your patient

Question 14

What is the prognosis of the injury dependent on?

Answer 14

Type, location and severity of the injury
Age
Even with surgery, some people experience permanent disability, ranging from weakness in the hand, shoulder or arm to paralysis

Question 15

Does Erb-Duchenne Palsy affect the superior or inferior part of the plexus?

Answer 15

superior part of the plexus

Question 16

How does Erb-Duchenne occur?

Answer 16

Due to excessive increase in the angle b/t the neck and shoulder: nerve roots C5,C6 involved and muscles of the shoulder and arm

Question 17

True or false: waiter’s tip position is involved in Erb-Duchenne?

Answer 17

True:•Waiter’s tip position:
Characteristic position: adducted and internal rotation of the arm with forearm pronatedoForearm extension normal Biceps reflex absent

Question 18

What is the clinical appearance of Erb- Duchenne?

Answer 18

Clinical appearance:• Adducted shoulder• Medially rotated arm• Extended elbow
Also see a sensory loss on the lateral aspect of the upper limb( uncommon)• Waiter’s tip position:

Question 19

what is Klumpke Paralysis or Palsy?

Answer 19

Injury to inferior part of plexus

Question 20

How does Klumpke Paralysis occur?

Answer 20

•Excessive abduction of the arm
Less common then injury to the superior part of the plexus• Could occur from a person grasping something to prevent a fall (tree branch or birth)

Question 21

Is Klumpke Paralysis a superior or inferior injury of the brachial plexus?

Answer 21

Inferior:Roots involved: C8 and T1

Question 22

Clinical appearance:

Answer 22

• Motor loss: small muscles of the hand• Sensory loss: medical aspect of the upper limb

Question 23

What aspect of the plexus is injured in claw hand?

Answer 23

•Plexus lesion (C8-T1) ulnar, and/or median n. injury

Question 24

Clinical appearance of claw hand:

Answer 24

All fingers are clawed

Hyperextension at the mcp joints, flexion at the ip joints

Question 25

True or False: Cervical rib is common, especially in the elderly.

Answer 25

False:It is a rare condition

Question 26

Does cervical rib involve the superior or inferior aspect of the plexus?

Answer 26

it involves the inferior part of plexus

Question 27

What types of treatment can be done for an injury to the brachial plexus?

Answer 27

Surgery repair due to the risk of muscle atrophy

Question 28

Within how much time should the surgery be done?

Answer 28

3-6 mo. after the injury

If wait more than 1year after injury, the success rate drops

Question 29

How fast does nerve tissue grow?

Answer 29

Nerve tissue grows slowly ( about 1 inch/month)

Question 30

How long could it take to recover from surgery?

Answer 30

can take several years to fully recovery after surgery

Question 31

True or False: It is important to respect the pt’s pain?

Answer 31

True: Pain must be respected

Question 32

Occupational therapy goals:

Answer 32

Minimizing boney deformities and joint contractures, while optimizing functional outcomes
Passive and active ROM exercise

Question 33

Bimanual activities

Answer 33

Strengthening
Promotions of sensory awareness
Weight bearing activities: proprioceptive input + skeletal grown
Static and dynamic splints
Instructing parents and family: home exercise program