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Paediatric Interventions > Brachial Plexus Injury > Flashcards

Brachial Plexus Injury Flashcards

1
Q

What is the brachial plexus?

A

Complex network of nerves arising from the cervical spine and across the shoulder to the upper limb

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2
Q

What is an example of a brachial plexus injury in newborns?

A

Traction injury to shoulder during delivery of the head

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3
Q

What are the characteristics of a brachial plexus injury?

A
  • Stretching of the nerve of brachial plexus
  • Weak or paralysed UL
  • Passive > active ROM
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4
Q

How are brachial plexus injuries categorised?

A

Gilbert & Tassin/Narakas:

  • I: C5, 6 (deltoid, biceps)
  • II: C5, 6, 7 (deltoid, biceps, triceps, wrist extensors)
  • III: C5, 6, 7, 8, T1 (flail arm)
  • IV: C5, 6, 7, 8, T1 (flail arm, with Horner’s syndrome)
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5
Q

What is the waiter’s tip position?

A

Shoulder adduction/IR with wrist flexion & finger extension

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6
Q

What is Klumpke’s palsy?

A
  • Flaccid hand in otherwise active arm
  • Lower plexus palsy
  • Extremely rare
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7
Q

What is “Pan” plexopathy?

A
  • Total plexus palsy

- Groups III & IV with total loss of function of the arm (flail arm)

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8
Q

What is neuropraxia?

A
  • Transient nerve injury
  • Brief ischaemic episode
  • Compression, demyelination, axonal constriction or stretch
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9
Q

What is axonotmesis?

A
  • Transient or permanent nerve injury

- Disruption of axonal nerve fibres with majority of supporting structures of the nerve ok

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10
Q

What are the characteristics of a likely permanent nerve injury?

A

Axon lesion with some or all supporting structures also damaged

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11
Q

What are the characteristics of a permanent nerve injury?

A
  • Neurotmesis (complete rupture)

- Location important too in relation to motor body

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12
Q

What is the likely clinical picture of brachial plexus injuries?

A
  • Shoulder extension, IR, adduction
  • Elbow extension
  • Forearm pronation
  • Wrist, finger flexion
  • Grasp may be ok
  • Sensory loss present (neglect possible)
  • Paralysis
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13
Q

When are babies with brachial plexus lesions seen by physio?

A
  • Usually on post-natal ward then as OP
  • Clinical exam at 2-4 weeks key for mapping probably sit of injury
  • Birth hx & any activity since then noted
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14
Q

What is assessed by physio at 2-4 weeks in babies with brachial plexus injuries?

A
  • Position at rest
  • Active movement
  • Movement with stimulation
  • Passive range
  • Head position & neck ROM
  • Clavicle & humerus integrity
  • Reflexes
  • Eyes (miosis, ptosis, Horner’s syndrome)
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15
Q

What movements are observed in supine, sidling & prone in babies with brachial plexus injuries?

A
  • Spontaneous movements
  • PROM (limited = suspect other impairments)
  • AROM (stimulation i.e. stroking, tapping, vibrating muscle belly)
  • Against/across gravity
  • Scapula winging
  • Chest expansion
  • Reflexes
  • Sensory responses
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16
Q

What are the standardised assessments used for brachial plexus injuries?

A
  • Active movement scale for newborns
  • Mallet scale for children
  • PEDI (ADL focus)
17
Q

What are the medical/surgical assessments used for brachial plexus injuries?

A
  • Electrodiagnostic examination
  • Nerve conduction studies
  • EMG
  • CT
  • MRI
18
Q

What is the treatment for brachial plexus injuries?

A
  • Protect arm
  • Pain relief if required
  • Review 2 weeks
  • Gentle ROM/stimulation exercises from 2 weeks
  • Stretching to prevent loss of ROM
  • Developmentally appropriate stimulation (tummy time, sidelying)
19
Q

What are some of the AROM exercises for babies with brachial plexus injuries?

A
  • Stroking, tapping or vibration in gravity eliminated position, then anti-gravity, then weight-bearing position
  • Hand to face with bicep stroking
  • Elbow extension to overhead toy
  • Wrist extension to reach toy
  • Weight bearing through UL over a ball
  • Arm into visual field to minimise neglect
20
Q

What are some of the prognostic signs in babies with brachial plexus injuries?

A
  • Shoulder ER & forearm supination
  • Biceps function
  • Elbow extension/flexion at 1 month with EMG motor unit potential
21
Q

What are some of the longer-term treatment options for babies with brachial plexus injuries?

A
  • Neurosurgery (nerve graft/transfer)
  • Secondary MS surgery
  • Serial casting
  • Constraint induced therapy

Paediatric Interventions (27 decks)

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