Brachial plexus injury Flashcards
What is the primary etiology of Brachial Plexus Injury (BPI)?
Traction on newborn’s shoulder during delivery and forceful head traction/rotation injures C5-6 roots
Other factors include birth weight >90% percentile, shoulder dystocia, and maternal conditions.
What is the pathophysiology of BPI?
Damage to nerve structures along the brachial plexus involving the nerve roots, trunks, divisions, cords or peipheral nerves
What are the three types of brachial plexus lesions?
- Neurotmesis
- Axonotmesis
- Neuropraxia
What is Neurotmesis?
Avulsion from the spinal cord or complete rupture
What is Axonotmesis?
Disruption of axons while the endoneurium remains intact
What is Neuropraxia?
Temporary nerve conduction block with intact axons
What factors contribute to the prognosis of BPI?
Type of injury and severity of injury
Severity may not be known initially and is determined later.
What is the recovery prognosis for Neurapraxia?
Best chance of recovery is days to weeks with edema resolution
What is the recovery prognosis for Neurotmesis?
Unlikely to recover on its own; often requires microsurgical repair or reconstruction
What is the recovery prognosis for Axonotmesis?
Better recovery than rupture; regrowth ~1mm/day, proximal recovery in 4-6 months, distal in 7-9 months
What are the four types of the Narakas Scale classification for BPI?
- Type 1: C5-C6 (Erb’s palsy)
- Type 2: C5-C7 (extended Erb’s)
- Type 3: C5-T1 (flaccid paralysis)
- Type 4: C5-T1 (flaccid paralysis plus Horner’s Syndrome)
What are typical presentations of Erb’s Palsy?
Shoulder extension, IR, adduction, elbow extension, forearm pronation, wrist and fingers flexed in waiter’s tip position
Involves weakness in shoulder, elbow, and wrist musculature
What can accompany Erb’s palsy?
- Unilateral diaphragmatic paralysis C4
- Usually resolves spontaneously in 6-12 months
What is Klumpke’s Palsy characterized by?
Forearm rest in supination with paralysis of wrist and finger flexor/extensor muscles , often accompanied by Horner’s syndrome
What nerve roots are involved in Klumpke’s palsy?
C8-T1
Caused by shoulder ABD and backward rotation during birth
What is the role of MRI and CT in BPI assessment?
MRI and CT are used to assess the condition; MRI is preferred
What should a PT measure specifically when evaluating a pt with BPI?
PROM of:
Scapulohumeral angle (SH) in abduction
SH angle add
SH angle in horizontal add
GH IR & ER arc of motion in 90 abd and elbow flex at 90
What is the purpose of the Active Movement Scale?
To measure muscle activation and movement function in infants
Narakas motor grading system
- M0 - no contraction
- M1 - contraction without movement
- M2 - incomplete movement
- M3 - complete movement with apparently normal force
Narakas Sensory grading system
- S0 – no reaction to painful or other stimuli
- S1 – reaction to painful stimuli; none to touch
- S2 – reaction to touch; none to light touch
- S3 – apparently normal sensation
What is the FLACC scale?
- Face
- Legs
- Activity
- Cry
- Consolability
What is the Brachial Plexus Outcome Measure and Activity scale? (BPOM)
- 4-19 years old
- tests quality of UE movement during 11 activities aimed at measuring movement patterns which are often dysfunctional in children with BPI
What are common PT interventions for infants with BPI?
- PROM to neck and UE joints
- Positioning strategies
- Therapeutic play activities
What is the goal of sidelying positioning strategies in BPI treatment?
- Affected side encourages isolated elbow flexion and shoulder motion
- unaffected side encourages shoulder motion
- reduce sustained IR of affected side when lying on unaffected side
What is the goal of prone positioning strategies in BPI treatment?
- passively stretch GH joint into ER and horizontal ABD
- When appropriate can allow for prone on elbows on therapy ball
What is important with stretching for BPI patients?
- Avoid overstretching
- Placing UE in optimal positions while resting
- Scapular stabilization is important with stretching
What is the goal of supine positioning strategies in BPI treatment?
Important to place elbows and hands in front of shoulders to prevent posturing into shoulder ext
What potential impairments may arise from BPI?
- Muscle atrophy
- Shoulder impairment
- Contractures
- Developmental apraxia
- Positional torticollis
- Substitutions for weak muscles
- Diminished sensation
- Atypical bone growth
What are the expected outcomes for infants with Total Plexus Palsy?
Flaccid upper extremity with motor and sensory deficits, worst prognosis
What is the significance of sensory awareness in BPI rehabilitation?
To prevent neglect or self-abuse of the affected limb
