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A: pediatrics > Brachial Plexus Birth Injury - Guest Lecture > Flashcards

Brachial Plexus Birth Injury - Guest Lecture Flashcards

1
Q

What is in teh CNS

A

Posterior (dorsal) horn

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2
Q

What is in the PNS

A
  • dorsal root & rootlets
  • ventral horn , ventral root
  • dorsal root ganglion
  • spinal nerves
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3
Q

How is the recover and fibers from a nerve transfer

A

Faster recovery , more fibers

graft takes longer for recovery

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4
Q

How is the recover and fibers from a nerve grafting

A

Slower recovery , more fibers

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5
Q

What allow peripheral nevers to regenerate

A

Schwann cells

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6
Q

What is a major limiting factor for brachial plexus surgery

A

Nerve regrowth

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7
Q

Long bone growth during growth spurts is problematic for ____

A

contractures

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8
Q

When does remodeling potential decrease for GHJ development

A

At 4 years old

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9
Q

What is the scapulohumeral kinematics

A

2;1 ration

For every 3 degrees of overall arm elevation about 2 ° come from humeral movements and 1° from scapular movement

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10
Q

What are maternal risk factors for BPI 6)

A
  • Advance age > 35 yrs.
  • Pelvic anatomy
  • High BMI
  • Infections
  • Gestational Diabetes
  • Primiparity (first time mother)
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11
Q

What are labor and delivery risk factors for BPI

A
  • High birth weight (> 4 kg)
  • Breech position
  • Shoulder dystocia
  • Forceps or vacuum
  • Clavicle fracture
  • Previous births with BPBI
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12
Q

Is BPI usually unilateral or bilateral

A

Uni

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13
Q

How long does it take for a clavicle fx to heal and how long should u immobilize it for

A

21 says to heal and immobilize for 14 days

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14
Q

How long does it take for humeral fx to heal and how long do u immobilize it for

A

6 weeks
Immobilize for 4 weeks

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15
Q

How kind of pain do newborns have, following BPBI

A

Nociceptive (somatic) pain

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16
Q

Babies may guard the injured area so what should u look for in an infancy with BPBI

A

Look for gaze preference
Ipsilateral torticollis

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17
Q

Babies with BPBI will have TTP where

A

Supraclavicualr area and neck

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18
Q

What asymmetry may be present with kids with BPBI

A

• Head shape
• Gaze preference
• Torticollis
• Eyelids and pupils
• Chest rise

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19
Q

What is Horner’s sign

A
  • Partial ptosis (dropping or falling of upper eyelid)
  • miosis (constricted pupil)
  • facial anhidrosis (loss of sweating0
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20
Q

What is Horner’s sign indicative of

A

A T1 nerve root avulsion

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21
Q

T/F: torticollis affects the probability of recovery from BPBI

A

False it does not

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22
Q

T/F: majority of BPBI pateints have ispilateral head tilt and contralateral rotation

A

True

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23
Q

If a patient had PLAGIO/BRACHYCEPHALY
When does remodeling potential decreased significantly

A

After 9 months of age

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24
Q

What are the myotomes for C5-T1

A

C5: abduction of arm
C6: elbow flexion
C7: elbow extension
C8: finger flexion
T1: abduction and adduction of index, middle and ring fingers

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25
What will a pateint with a C5,C6 injury have
Elbow extension and wrist extension
26
What will a baby with C5,C6,C7 injury lack
Wrist ext and elbow flexion
27
What ages is the **active movement scale** used for and what diagnosis
0-8 years BP
28
If there is **shoulder abd** occurring only in concert with **shoulder IR and horizontal adduction** what mm is on
Pec major not the delts
29
What is the difference between pec major vs deltoid
• Shoulder stays mostly adducted • Whole arm is off the mat • Cubital fossa pointing at his body (shoulder IR) • No active shoulder abduction
30
Does scapular retraction equal shoulder ER.
No
31
In **supine**, an infant has **unopposed ___ rotators** and when they ”relax” it appears they have ___ rotation
internal External
32
In a **C5,C6 injury** a baby with **unopposed elbow extension** , **relaxing of the triceps** casues what
A rebound into elbow flexion
33
What PROM should u do to **prevent dysplasia/dislocation** of shoulder
Shoulder ER/adduction
34
What **PROM** should u **check every session** with a BPI
ER and adduction
35
What kind of **contracture** is common **< 3 months of age**
Elbow flexion
36
What are common contractures for BPBI
• Scapulohumeral angles • Elbow flexion contractures • Forearm pronation contractures • Forearm supination contractures (global injuries) • Long finger flexor tightness • Intrinsic minus hand • Thumb in the plane of the hand
37
When does. A baby **perform purposeful reach**
3-9 months
38
When does a baby have **bilateral coordination**
9 months to 12 years
39
Can the AIMS but used for BP
Yes
40
What is the Preferred imaging for primary nerve surgery planning
Magnetic resonance imaging
41
When would it be **recommended** for an **US** to be ordered
If < 60° of ER/adduction
42
30% of patients with BPBP had ___ dislocation in the first year of life
posterior
43
What is a **concave glenoid deformity**
Round humeral head centered in a glenoid with a matahcing curve
44
What is a **flat glenoid deformity**
Flattening of the posterior aspect of the glenoid
45
What is a **biconcave glenoid deformity**
2 concave portions of the glenoid , with humeral head restring on posterior portion
46
What is a **pseudoglenoid deformity**
retroverted posterior aspect distinct from original articular surface of the glenoid
47
In babies wiht BPBI it is most important to prevent what kind of dislocation of the humeral head
Postieor
48
What **HEP** tends to be the **least** tolerated by the pateints
Shoulder ER/ADD
49
If a baby has a **contracture** what should u do
Passively stertch and hold them
50
What must u do to effectively stertch the **GHJ**
Block the scapular from lateral rotation
51
How do u place the **biceps** on **full stertch**
Composite elbow extension and forearm supination
52
What is one of the **most difficult contractures** to **remediate**
Volkmann’s contracture
53
How should u do wrist and finger extension for HEP
First put the wrist into extension and then stretch the fingers but avoid hyperextension of MPJ
54
What position does the **HERO strap** put the baby in
Abduction and ER
55
What does the hero strap correct and allow
Correct shoulder IR , pronation Allows shoulder and elbow AROM
56
What is a hands on therapy approach to maximize limited repertoire of movement patterns
NDT
57
What is the difference between habilitation vs rehabilitation
Habilitation is that the person is trying to learn something new for the first time Rehabilitation is when. The person is trying to learn what they already knew but it was impaired
58
When should u **not do Botox to IR**
Past 8-9 months
59
What is neurolysis
Separation of adhesion from the nerve
60
What is **neruolysis** usually accompanied by
* nerve grafting * nerve transfer Or both
61
What is the Removal of neuroma and associated scar usually creates a gap too large for primary repair
Nerve grafting
62
A single ___ nerve provides ~ 15-20cm of graft
sural
63
What kind of grafting increases the number of motor neurons across the gap
Cable
64
____ allow ONLY ___ nerves to regenerate as they contain nerve growth factor (NGF)
Schwann Peripheral
65
Nerve regrowth occurs approximately __- mm per day or __1_ inch per ___
1 Month
66
Where should u test sensation for a kid with BPBI
Median nerve: middle finger Radial: dorsum of hand ulnar: lateral hand
67
What age is the **modified mallet classification** for and what **diagnosis**
3+ and BP
68
What **actions** are u testing with the **modified mallet classification** (6)
* global abduction * global ER * hand to neck * hand to spine * hand to mouth * IR
69
What is **Not standard of practice** for infants who are being considered for primary nerve surgery
EMG
70
What are **secondary** orthopedic surgeries
* anterior release * humeral de rotational osteotomy * latissimus transfer
71
• Desired age for initial evaluation within a specialty care clinic • Clavicle fractures are healed • Humeral fractures are mostly healed • Differential diagnosis is easier What age is this
1 month
72
What is the **desired age** for surgical interventions in infants with global BPBI (C5-T1)
3 months
73
What is disruption of T1 n root
Horners
74
When will there be evidence of nerve root avulsion
3 months
75
What age is when majority of BPBI patients **shoulder dislocate**
3-6 months
76
60-80% of infants with motor deficits beyond **3 – 6 mos.** develop ___
Dysplasia
77
What is the **age range** when **most primary n surgies** take place
6-12 months
78
What is the age cutoff for non-surgical management of glenohumeral dysplasia and dislocation (Botox/casting)
9 months
79
When must the **shoulder reduce** with **ER/ADD**
9 months
80
When is the **last line of defense** before major, orthopedic surgery
9 months
81
What is the **age cutoff** for all **primary nerve surgeries**
15 months
82
What is the Desired age for secondary, orthopedic procedures to address glenohumeral dysplasia and dislocation
2-4
83
When is **GHJ remodeling** potential is the **highest**
2-4 years old
84
What is the Cutoff” for **releases and tendon transfers** at the GHJ
4-5 years
85

A: pediatrics (38 decks)

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