Brachial plexus injury Flashcards
What is a BPI
- weakness of total paralysis of muscles innervated by the brachial plexus C5-T1
What are non-obstetric causes of BPI
- contact sports esp wrestling and football
- high speed impact accidents (motorcycle, bicycle, car)
- falls
- industrial accidents
- tumors of the neck
- viral disease
What are the symptoms of Brachial plexus injuries
in adults
- in adults will see muscle weakness and atrophy
- possible changes in sensation and reflexes
- may have signs of trauma
assoicated injuries of Brachial plexus injuries in adults
- throacic trauma: abrasions or fractures
- fracutres or dislocations
- spinal cord injury or brain injury (may not realize at first there is Brachial plexus injury)
Upper erbs palsy
- shoulder abduction/external rotation
- elbow flexion affected
- good spontaneous recovery expected over 80% of cases
Extended Erbs C5-C7
- shoulder abduction/ER and definite wrist drop
- good spontaneous recovery in about 60% of cases
- C7
Total palsy with no horner syndrome
C5-T1
- complete flaccid paralysis with horner syndrome
- the worst outcome
- without surgery, severe defects throughout the limb functon
- visual system involved
- need muscle transplant
Total palsy with horners syndrome
- C5,C6,C7,C8 T1
- complete flaccid paralysis with horners syndrome
- the worst oucome
- without surgery severe defects throughout the limb function
Horners syndrome
- ptosis
- anhydrosis (semi-anhydrosis)
- enophthalmos: sucken in eyes
- meiosis
upper plexus damage in adults is commonly injured how?
- forcibly thron from vehicle
- land on shoulder
- tends to happen if arm is in front of body or arm is adducted
lower plexus injuries in adults is injured how
- arm abducted over head
- traction force
- caught in a machine
- most common industrial MOI
total plexus injury: how does this happen in adults
- heavy blow to shoulder from above
- violent downward traction
- thrown from vehicle and arm is behidn body
- likley to occur if arm s abducted and forces behind trunk
how is BPI diagnosed in adults
- radiographs
- CT myelograms: use contrast medium to evaluate nerve roots
- MRI (T2-weighted)
- EMG
why is T2 MRI used
- nerve tissue and edema show bright on this type of MRI
PT interventions for brachial plexus injury
- first 7-10 days no intervention (healing)
- promote active functional movement
- inhibit abnormal substitutions
- scapular stabilization
- ROM
additional considerations for brachial plexus injury
- botox injection
- KT tape
- e-stim
- serial casting
indications for use of botox
- interal rotation or adduction contracture: iject pectoralis and occasionally the lat
- limited active elbow flexion: inject triceps
- limited active elbo extension: inject biceps, brachialis and brachioradialis
- pronation contracture: inject pronator teres
surgical procedures for adults indications for acute and delayed surgical exploration
indications for actue surgery
- open wound, crush injury
- clinical or diagnostic indications of nerve root avulsion
delayed surgical exploration
- closed ijury
- no EMG changes by 12 weeks
- EMG can be sued to determine where injury is and how extensive
Types of primary nerve Surgeries
- neurotization: nerve transfer using uninjured nerve
- neurolysis: cleaning up scar tissue on neuroma most common
- nerve graft: with donor nerve (your own or allograph)
Secondary surgeries
- repair muscular imbalance
- repair skeletal deformities
muscle transfer surgery
- allo for improved shoulder elevation and ER
- release subscap
- axillary nerve decompression and neurolysis
- transfer of lat
- transfer of teres major
- release of pectoralis major and minor
dont memorize
Biceps tendon lengthening
- shortening of the biceps muscle due to muscle imbalance between the biceps and triceps
- at risk for bony deformity
- improves length and function/growth
- if mild can first try myofascial release stretching, serial casting, botox, or splinting
Surgeries for resultant bony deformities
- triangle tilt surgery
- humeral osteotomy
- shoulder arthrodesis/fusion
what is a triangle tilt surgery
- Spinous process/acromion process osteotomy
- bone graft
- clavicular osteotomy
- scapular osteotomy
- anterior glenohumeral release and subscap tendon lengthening
- subscap tendon transfer
- pec major and minor release
- glenohumeral capsulodesis
what is a humeral osteotomy
- humerus is ER and fixed usually with plates and screws
- helps improve the use of the deltoid muscle
Arthrodesis/fusion
- rarely done
- usually only if there is a lot of pain or loss of function
- typically only when other forms of reconstruction have failed
- not kuch literature regarding this procedure with children with BPI
