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Peds > Brachial Plexus Injury > Flashcards

Brachial Plexus Injury Flashcards

1
Q

Injury to brachial plexus usually occurs during

A

Difficult vaginal delivery (forceful contraction and rotation of head tends to injury c5c6 nerve root)

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2
Q

Birth weight contributing to brachial plexus injury

A

> 3500g

Infant w/ a birth weight of 4500g had a risk of OBPI 45 times higher than a baby less than 3500 G

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3
Q

Other factors contributing to brachial plexus injury

A 
Difficult delivery of the shoulder
Prolonged maternal labor
Maternal DM
Sedated hypotonic infant during delivery
Breech delivery
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4
Q

Pathophys: brachial plexus damage can occur

A

Anyway along the pathway

Rootlets, roots, trunks, divisions, cords, peripheral nerves

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5
Q

Neurotemesis

A

Complete rupture of nerve

May develop into neuroma or mass of fibrous tissue

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6
Q

Axonotemesis

A

Distrution of axon while sheath remains intact

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7
Q

Neurapraxia

A

Temporary nerve conduction blockage

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8
Q

Axon regrowther proceeds

A

At 1mm per day
Majority of recovery takes 4-6 mo in Upper arm
7-9 months in lower arm
Continuous recovery can occur up to 2 years in upper arm and 4 in lower

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9
Q

Erbs palsy

A

Most common
C5 and C6 nerve roots
Childs shoulder held in extension, IR, ADD,
Below ext, forearm pronation, and and fingers flexed

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10
Q

Erbs palsy paralysis

A 
Rhomboids, levator, serratus, subscap
Deltoid, infraspinatus, teres minor
Biceps brachialis, supinator 
Brachioradialis 
Fiber and thumb extensors
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11
Q

Klumpke’s palsy

A

Rare, usually from breech delivery w arm overhead
Involvement of lower nerve roots of C7-T1
Childs shoulder and elbow not impaired
However resting position of forearm is sup, elbow flex, paralysis of wrist flexors and extensors and intrinsics

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12
Q

Erb-klumpke palsy

A

Combo of upper and lower nerve roots resulting in total arm paralysis and loss of sensation

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13
Q

Horners syndrome

A

Can occur w/ avulsion of T1 roots presenting as decisive to sweating, recession of eyeball, decreased pupil size, partial drooping of eyelid, and irises are different color

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14
Q

Substitution during period of neural regeneration -BPI

A

Medial rotated shoulder w/ forearm pronation and wrist flexion when grasping
May neglect impair contractures arm
Can lead to and abnormal bone growth

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15
Q

Recovery rate BPI

A

60-80%

Some have spontaneous recovery w/in a few weeks
Recovery in shoulder ER has been shown to accurately predict full recovery

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16
Q

Brachial plexus injury activity limitations

A

Inability to reach, grasp, bilateral tasks
Developmental delays or asymmetry (ruling and supine to sit may always be done from one side)
Quad position and creeping may not occur due to inability to WB on involved arm
Neglect or self abusive behavior

17
Q

PT exam followed at

A

2 weeks, 1, 2, 3, months

If not recovery evident an MRI may be performed to define nerve root integrity

18
Q

Active movement scale gravity eliminated

A 
0 no contraction
1 contraction, no motion
2 motion less than or equal to half range
3 motion grater than half range
4 full motion
19
Q

Active movement scale - against gravity

A

5 motion less than or equal to half range
6 motion grater than half range
7 full motion

20
Q

Sensory grading for kids with BPI

A

S0 no reaction to painful or other stim
S1 Rx to pain, not touch
S2 rx to touch, not light touch
S3 apparently normal sensation

21
Q

Sensation may take ___ to recover

A

As long as 2 years

22
Q

Procedural intervention - initial rest period

A

7-10 days after birth
No ROM
Limb positioned across abs
Avoid lying on limb

23
Q

Procedural interventions after rest period

A

PE eval
HEP w/ ROM
Parent ed on risk of dislocation and sensory loss issues
Strengthing activites through play

24
Q

Active movement

A

Facitlate normal patterns
Inhibit substitutions during reaching and WB activities
(Watch/ support scapula)
Eliminate gravity for weak muscles
Hand to mouth, transfer objects, weight shift on propped UE
Sidelying on uninvolved arm to free involved to work on reaching
Push up to sit from involved side
Bilateral activities

25
Q

ROM

A

Avoid overhead stretching unstable joint
Don’t puck up under axilla
Stretch scapulohumeral muscles
Botox and casting to improve elbow ext

26
Q

Sensory awareness

A

Can lead to neglect self mutilation
Games to ID or find objects w/ involved hand
Play w/ various temp and textures

27
Q

Positioning and splinting

A

While sleeping arm can be placed in ABER, elbow flex, supination on pillow
Wrist splints to prevent contracture
Constrain uninvolved arms for short periods of time

28
Q

Neurosx

A

Only done in 5-10% who do not show spontaneous recovery

Nerve grafting, NeuroM dissection and removal, neurolysis, direct end to tend anastomosis

29
Q

OBPI GH deformity

A

Up to 67%

30
Q

OBPI most common contracture

A

Shoulder ADIR, elbow flex or ext, supination

31
Q

OBPI main purpose of sx

A

Allow enough PROM for self care activities

32
Q

Scapulohumeral mobility

A

Develops b/n 3-6 months
Elongation of muscle b/n humerus and scap and humerus and ribs occur during transitions movements of supine to sidelying and supine to prove
Weight o trunk loaded onto upper arm
Reaching in prone stimulates new range

33
Q

Facilitating scapular thoracic activity

A

Stability for mid range reaching
Active thoracic ext prevents excessive scapular winging
Initially developed in prone play as early as 2 mo
As child develops enduriance in spinal ext, reach can be added

34
Q

Increasing shoulder girdle and elbow strength

A

Fascilitation of movements in which the child uses arms to push from one position to another
Around 5 mo
Sidelying to sitting, sitting to quad and creeping

35
Q

Developing isolated elbow movements

A

Hand to body play
-emerges around 3 mo in supine
Manip toys in prone on elbows
Activating and exploring toys

36
Q

Isolated control of forearm and wrist

A

Emerges around 5 mo w/ prone on elbow play

Self feeding

37
Q

Facilitating hand functions

A

Weight shift on extended arms helps to expand the hand so it will be malleable enough to actively arch during grasp and manipulation
Helping child grasp w. Wrist in neutral will facilitate balance between f/e
Development of release requires child to learn to use long finger flexors for a point of stability

38
Q

Neurosx age and prevalence

A

Optimally performed b/n 3-8 months

Outcomes better for those w/ upper root involvement

Peds (18 decks)

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