Brachial Plexus Injury BPI

Question 1

Classification of BPI

Answer 1

Neuropraxia

• mildest injury, most common
• STRETCH/TRACTION injury
• intact nerve, conduction block
• recovery ~ 3mo

Axonotmesis

• PARTIAL RUPTURE - nerve intact, axons not continuous
• regeneration through axon sprouting
• recovery ~1in/mo

Neurotmesis

• most severe - nerve interuption
• RUPTURE = nerve torn distal to spinal column - recovery only with surgery
• AVULSION = nerve root torn from spinal cord - no regeneration

Question 2

Risk Factors for BPI

Answer 2

• Incidence = .38-2.6/1000 live births
• forceps delivery
• high birth weight
• breech presentation
• prolonged delivery
• shoulder dystocia*
• maternal diabetes
• intrauterine torticollis
• multiparity
• vacuum extraction

Question 3

Associated Injuries

Answer 3

• clavicular and humeral fx/dislocation
• torticollis
• cephalohematoma
• facial nerve palsy
• diaphragmatic paralysis, phrenic involv.

Differential DX: torticollis, hemiplegia, congenital spinal atrophy, need xray, MRI and EMG~2-3weeks

Question 4

Physical Findings with BPI

Answer 4

• arm positioned loosely at side; can be flaccid dependent on extent of injury
• Erb’s Palsy - injury to C567 = Waiters tip
• Klumpke’s Palsy - injury to C8T1 - elbow flexion and wrist extension
• possible respiratory involvement
• assymetric posture and movement
• lack of ABD, ER, elbow flexion, FA supination
• absence of physiological flexion in infancy
• intrinsic hand weakness

Question 5

Physical Therapy Exam and Sensory Grading

Answer 5

• Sensory grading

S0 = no reaction to painful or other stimuli

S1 = reaction to painful touch

S2 = reaction to touch, not light touch

S3 = normal sensation

Question 6

Physical Therapy Treatment

Answer 6

initial treatment

• rest 1-2 weeks
• gentle ROM avoid traction
• HEP - positioning humerus in ABD/ADD with elbow flexion
• picking up child from under the axilla is CONTRAINDICATED

Positioning

• arm should be in ABD, ER, Elbow flex, FA Supination
• stabilize involved scapula during reaching activities to elongate the muscles that connect the scapula to the humerus during the initial 30 deg ABD

Question 7

Age Appropriate Complications

Answer 7

limb length discrepancy

joint/ms contracture

radial head dislocation

shoulder dislocation

scoliosis

osteoporosis

sensory/neglect