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Neuro Rehab Final > Brachial Plexus Injury > Flashcards

Brachial Plexus Injury Flashcards

1
Q

What are two different MOI for brachial plexus can be injured at birth?

A
  1. traction

2. Compression

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2
Q

How does traction cause BPI?

A

uneven decent of one shoulder vs other shoulder becomes stuck @ mother’s pubic symphysis anterior, sacrum posteriorly

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3
Q

How does compression cause BPI?

A

combination of abnormally shaped uterus and position of fetus

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4
Q

Where can a BP lesion be in SC?

A
  1. at level of nerve rootlet
  2. at anterior and posterior rootlets
  3. at distal to where the rootlets form mixed nerve roots
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5
Q

What is etiology of BPI?

A

difficult vaginal delivery, congenital abnormalities

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6
Q

What are risk factors for BPI in regards to the infant?

A
  1. high birth weight over 3500 g

2. sedated infant during delivery from meds given to mom leads to low tone

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7
Q

What are risk factors for BPI in regards to the mother?

A

maternal diabetes, prolonged maternal labor, breech or shoulder dystocia

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8
Q

What are three types of BPI lesions?

A
  1. neurotmesis
  2. Axonotmesis
  3. neurapraxia
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9
Q

What is neurotmesis?

A

rupture or avulsion of BPI, axon, myelin and connective tissue avulsed, no regeneration possible, can be partial or complete

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10
Q

What can result as sequelae from neurotmesis?

A

fibrous mass formation, hemorrhage into subarachnoid space (diagnostic indicator for avulsion)

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11
Q

What is axonotmesis?

A

disruption of axons with intact neural sheeth, regeneration is possible

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12
Q

What is neurapraxia?

A

temporary nerve conduction block, intact axons good prognosis

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13
Q

What are signs and symptoms of a BPI?

A

spinal cord level c5-T1, motor and sensory innervation, decreased spontaneous movement, absent moro reflex, absent grasp, Horner’s syndrome

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14
Q

What is Horner’s syndrome?

A

if sympathetic chain is involved- mitosis (contracted pupils), ptosis and anhidrosis (lack of face sweating)

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15
Q

What is a big indicator of a positive outcome in recovery for BPI?

A

are the neural sheaths still intact if they are than neurons can still reconnect

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16
Q

What is regeneration rate of axons?

A

1 mm/day, upper arm 4-6 mo., lower arm 7-9 mo., continues 2-4 years

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17
Q

How are BPI injuries classified?

A

based on spinal root level, severity of injury

Narakas usually used

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18
Q

What are examples of Narakas classification?

A

Upper Erb’s c5-6- 80% recovery rate

Total palsy with Horner’s syndrome c5-t1- worst outcome

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19
Q

What is Erb’s palsy?

A

most common type of BPI affecting upper plexus roots c5-c6 resulting in paralysis of shoulder. scap muscles, elbow forearms, wrist and fingers

20
Q

What muscles of shoulder are affected by Erb’s palsy?

A

deltoid, RC, SA, rhomboids, LS

21
Q

What muscles of elbow are affected by Erb’s palsy?

A

biceps, brachioradialias, brachialis, supinators

22
Q

What muscles of hand are affected by Erb’s palsy?

A

wrist extensors and finger extensors

23
Q

What are other possible impairments of Erb’s palsy?

A

sensation loss- lateral aspect of upper arm, can also have elbow extension if C7, “waiter’s tip resting position”

24
Q

What is most serious type of BPI?

A

Erb- Klumpke- also second most common ,global plexus palsy C5-T1, ms weakness

25
Q

What are other SE of Erb Klumpke?

A

initially clawed hand, insensate arm, may be incomplete, can have horners syndrome if avulsion at T1 root (rare)

26
Q

What is Klumke’s palsy?

A

lower plexus C7-T1

27
Q

What will pt have if they have pure Klumke’s palsy?

A

shoulder/elbow motions intact, weak grasp, forearm rests in supination

ms involved: wrist flexors and extensors, hand intrinsics (claw hand), weak elbow extension

28
Q

What are two types of medical management of OBPI?

A
  1. conservative- always preferable (3-4 months before surgery considered)
  2. surgical intervention- neurosurgery, ortho surgery
29
Q

What are the indications for neurosurgery?

A

no longer making progress, significant impairments/activity limitations

-lack of ER and supination

30
Q

What are different types of neurosurgery for BPI?

A

nerve grafting, neurolysis

outcomes mixed- level of evidence low

31
Q

What are goals for orthopedic surgery?

A

AROM and PROM for hand to head/mouth function, prevent deformities

32
Q

What is important information to ask during a history of BPI pts?

A

birth weight, older child- history of intervention, impact on functions

33
Q

What is important of MS systems review for BPI?

A

shoulder girdle integrity (winging, subluxation)

34
Q

What is important of NM systems review for BPI?

A

red flag- spasticity bc its and UMN sign

35
Q

What is important of CP systems review for BPI?

A

breathing patterns and norms, phrenic nerve damage- hemi elevated diaphragm

36
Q

What is important of integ systems review for BPI?

A

signs of self injury such as biting arm

37
Q

What type of movement grading systems is used for infants?

A 
Active movement scale 0-7
0- no contraction
1- contraction with movement
2- 1/2 ROM mvmt
3- more than 1/1 ROM mvmt
4- full mvmt

AG:
5- less than 1/2 ROM mvmt
6- more than 1/2 ROM movement
7- full movement

38
Q

What type of movement grading system is used for older children?

A

MMT, Mallet classification of UE function

39
Q

What is Mallet Classification of UE function?

A 
1- nothing
2- 1/3 of movement
3- 2/3 movement
4- almost full range 
5- full range
40
Q

What are two different types of movement tests used for BPI pts?

A
  1. towel test for biceps function- infants 0-3 months, towel over eyes restrict uninvolved limb and see how baby removes it
  2. Cookie test- 6-9 months, see if they can bring cookie to mouth via elbow flexion vs head and mouth
41
Q

What is Narakas sensory grading system?

A

S0- no reaction to painful stim.
S1- reaction to painful stim.
S2- reaction to touch
S3- normal

used for infants, older children use more formal tests

42
Q

What activity test is used for infants with BPI?

A

Tests of Infant Motor performance (TIMP)
- 0- 5months

older children use PDMS 2

43
Q

What is ultimate goal for POC for BPI pts?

A

age appropriate function, support spontaneous recovery

44
Q

What must be done for a newborn consultation with BPI?

A

rest and immobilization first 7-10 days, no ROM, position arm across abdomen, don’t lie on limb

45
Q

What can be done in PT after 10 days?

A

baseline exam, HEP, use of therapeutic play

CIMT can be used, try to avoid learned non use and promote B UE use

Neuro Rehab Final (10 decks)

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