Brachial Plexus Injury CSV

Question 1

What is Brachial Plexus Injury (BPI)?

Answer 1

• Brachial Plexus Injury (BPI) is damage to the network of nerves that control movement and sensation in the shoulder, arm, and hand.
• It can result from trauma or during delivery (e.g., Obstetric BPI).

Question 2

What are the two main types of delivery-related BPI, and how are they defined?

Answer 2

1. Obstetric Brachial Plexus Injury (OBPI): Occurs during childbirth due to traction or compression of the brachial plexus.
2. Neonatal Brachial Plexus Injury (NBPI): Detected in neonates, typically caused by birth complications.

Question 3

What are the four types of nerve lesions in BPI?

Answer 3

1. Avulsion: Nerve torn at the spinal cord attachment, most severe.
2. Rupture: Complete nerve tear not involving the spinal cord.
3. Neuroma: Scar tissue forms, compressing the nerve and blocking conduction.
4. Neurapraxia: Stretch injury without tearing, generally with good recovery.

Question 4

What is the most severe type of nerve lesion in BPI, and why?

Answer 4

Avulsion is the most severe type of nerve lesion because the nerve is torn at its attachment to the spinal cord, making it irreparable without surgical intervention.

Question 5

Define neuroma and how it affects nerve conduction.

Answer 5

Neuroma occurs when scar tissue forms around an injured nerve, compressing it and blocking proper conduction of electrical signals.

Question 6

What is neurapraxia, and how does it differ from other types of nerve lesions?

Answer 6

Neurapraxia is a stretch injury of the nerve without tearing. It differs from other lesions as it typically resolves without surgical intervention and has a good prognosis.

Question 7

What are the classifications of BPI based on nerve root involvement?

Answer 7

1. Erb’s Palsy: Involves upper nerve roots (C5-C6).
2. Klumpke’s Palsy: Involves lower nerve roots (C8-T1).
3. Global Palsy: Involves all nerve roots (C5-T1), resulting in total arm paralysis.

Question 8

Which classification of BPI is the most common, and what nerve roots are involved?

Answer 8

Erb’s Palsy is the most common classification, involving the C5 and C6 nerve roots. Sometimes C7 may also be affected.

Question 9

What is Klumpke’s Palsy, and which nerve roots does it involve?

Answer 9

Klumpke’s Palsy is a type of BPI involving the lower nerve roots (C8-T1). It is less common than Erb’s Palsy.

Question 10

What is Global Palsy, and how does it differ from Erb’s or Klumpke’s Palsy?

Answer 10

Global Palsy involves all nerve roots (C5-T1), leading to total arm paralysis and loss of sensation. It is more severe than Erb’s or Klumpke’s Palsy, which involve specific nerve root groups.

Question 11

What are common causes of BPI during delivery?

Answer 11

Common causes include shoulder dystocia, macrosomia (birth weight >4500 grams), prolonged labor, breech delivery, maternal diabetes, and use of mechanical assistance (e.g., forceps or vacuum).

Question 12

What role do traction and compression play in the development of BPI?

Answer 12

Traction (excessive pulling on the shoulder) and compression (pressure on the brachial plexus) during delivery can stretch, tear, or otherwise damage the nerves, leading to BPI.

Question 13

How does weight >4500 grams increase the risk of BPI?

Answer 13

Larger birth weight increases the likelihood of shoulder dystocia, where the shoulder becomes lodged against the pubic bone or sacrum during delivery, placing stress on the brachial plexus.

Question 14

What is the difference between OBPI and NBPI?

Answer 14

OBPI refers specifically to brachial plexus injuries occurring during childbirth, while NBPI is a broader term referring to any brachial plexus injury detected in neonates.

Question 15

What are the two primary mechanical factors contributing to BPI during delivery?

Answer 15

1. Traction: Excessive pulling on the infant’s shoulder or neck.
2. Compression: Direct pressure on the brachial plexus nerves, often due to shoulder positioning.

Question 16

What is the resting position characteristic of Erb’s Palsy?

Answer 16

The resting position of Erb’s Palsy is the ‘Waiter’s Tip’: shoulder extension, internal rotation, and adduction; elbow extension; forearm pronation; wrist and fingers flexed.

Question 17

What muscles are involved in Erb’s Palsy?

Answer 17

Involves rhomboids, levator scapulae, serratus anterior, subscapularis, deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, supinator, and long extensors of the wrist, fingers, and thumb.

Question 18

What is the clinical presentation of Klumpke’s Palsy?

Answer 18

Resting position is ‘Claw Hand.’ Shoulder and elbow movements are typically intact, but the intrinsic hand muscles and wrist/finger flexors and extensors are involved. Forearm may rest in supination.

Question 19

What additional syndrome is associated with Klumpke’s Palsy, and what are its symptoms?

Answer 19

Horner’s Syndrome is associated, caused by T1 avulsion. Symptoms include ptosis (drooping eyelid), miosis (pupil constriction), anhidrosis (reduced facial sweating), and iris color changes.

Question 20

What is the clinical presentation of Global Palsy?

Answer 20

Global Palsy involves total arm paralysis, with a mix of upper and lower root (C5-T1) injuries. It may present with Horner’s Syndrome and typically has the poorest prognosis.

Question 21

What are the sensory grading levels for BPI?

Answer 21

S0: No reaction to painful or other stimuli.
S1: Reaction to painful stimuli only.
S2: Reaction to touch but not light touch.
S3: Normal sensation.

Question 22

How does the Active Movement Scale (AMS) assist in evaluating BPI?

Answer 22

The AMS grades muscle activity in infants and young children, assessing voluntary movements without resistance. It is specific to conditions like BPI.

Question 23

What reflexes are commonly assessed during the physical examination for BPI?

Answer 23

The Moro reflex and palmar grasp reflex are commonly assessed to evaluate active movement and nerve function in infants with suspected BPI.

Question 24

What is the significance of asymmetrical Moro reflex in BPI assessment?

Answer 24

An asymmetrical Moro reflex indicates impaired motor function on the affected side, often correlating with the nerve roots involved in BPI.

Question 25

How is the Toronto Test used in BPI examination?

Answer 25

The Toronto Test is used to evaluate functional recovery in BPI cases, measuring joint range and motor function over time.

Question 26

What is the Mallet classification, and how is it used in BPI?

Answer 26

The Mallet classification is used to assess shoulder function in children with BPI, focusing on specific movements like abduction, external rotation, and hand-to-mouth motions.

Question 27

How does postural assessment aid in diagnosing BPI?

Answer 27

Postural assessment identifies asymmetries and abnormal resting positions of the shoulder, arm, or hand, aiding in localizing nerve root involvement.

Question 28

What is the purpose of ROM testing in BPI patients?

Answer 28

ROM testing assesses limitations in joint movement, helping to determine the extent of nerve injury and muscle involvement.

Question 29

What age-related differences must be considered in BPI strength testing?

Answer 29

Children under 5 years use qualitative assessments like MMT, while those over 5 may utilize quantitative tools like Biodex for more precise strength evaluation.

Question 30

What is the role of sensory testing in BPI evaluation?

Answer 30

Sensory testing helps identify areas of sensory loss or impairment, which can indicate specific nerve root injuries and guide treatment planning.

Question 31

What is the primary goal of physical therapy interventions for BPI?

Answer 31

The primary goal is to restore function, prevent secondary complications like contractures, and promote age-appropriate developmental skills in the affected upper extremity.

Question 32

What are the key components of a home exercise program (HEP) for BPI?

Answer 32

HEP includes gentle ROM exercises to prevent contractures, sensory stimulation to avoid neglect, and functional age-appropriate activities for the affected limb.

Question 33

Why is caregiver education essential in BPI management?

Answer 33

Caregivers are critical for implementing exercises and daily interventions, ensuring consistency in treatment and maximizing functional recovery.

Question 34

What role does sensory stimulation play in BPI management?

Answer 34

Sensory stimulation helps prevent sensory neglect and encourages reintegration of the affected limb into functional activities.

Question 35

What is the role of electrical stimulation in BPI treatment?

Answer 35

Electrical stimulation promotes muscle activation and can aid in reinnervation of affected muscles when combined with functional movements.

Question 36

What is modified constraint-based therapy, and how is it used in BPI?

Answer 36

Modified constraint-based therapy involves restricting the use of the unaffected arm to encourage the use of the affected arm, promoting motor learning and functional recovery.

Question 37

What splinting techniques are used for BPI, and what are their purposes?

Answer 37

Splinting is used to maintain proper joint alignment, prevent deformities, and support functional movements in the affected upper extremity.

Question 38

What is the role of kinesiotaping in BPI treatment?

Answer 38

Kinesiotaping provides support to weak muscles, reduces swelling, and enhances proprioceptive input in the affected upper extremity.

Question 39

When is Botox used in BPI management, and what is its purpose?

Answer 39

Botox is used to weaken antagonistic muscles, improving the balance of muscle forces and allowing for better movement in the affected arm.

Question 40

What percentage of children with BPI recover spontaneously with conservative treatment?

Answer 40

Approximately 2/3 of children with BPI recover spontaneously with conservative treatment methods.

Question 41

When is surgery typically indicated for BPI?

Answer 41

Surgery is indicated if there is no spontaneous recovery by 3-6 months, particularly if biceps function is absent by 3 months.

Question 42

What are common surgical procedures for BPI?

Answer 42

Common procedures include nerve grafts, nerve transfers, and tendon transfers. These aim to restore nerve or muscle function.

Question 43

At what age is surgery for BPI typically performed?

Answer 43

Surgery can be performed as early as 3 months but is typically done between 5-8 months for optimal outcomes.

Question 44

What is the purpose of tendon transfers in BPI treatment?

Answer 44

Tendon transfers reposition healthy tendons to compensate for paralyzed muscles, improving arm function.

Question 45

Why is early intervention critical in BPI management?

Answer 45

Early intervention prevents secondary complications, supports neuroplasticity, and maximizes the potential for functional recovery.

Question 46

A 3-month-old infant presents with a resting arm position characterized by shoulder internal rotation, elbow extension, forearm pronation, and wrist flexion. Which classification of BPI is likely, and what nerve roots are affected?

Answer 46

The infant likely has Erb’s Palsy, involving the C5-C6 nerve roots.

Question 47

A child has a resting hand position described as ‘Claw Hand,’ with involvement of the intrinsic hand muscles and forearm supination. Which classification of BPI is indicated, and what syndrome may also be present?

Answer 47

The child has Klumpke’s Palsy (C8-T1), which may present with Horner’s Syndrome.

Question 48

An infant with BPI shows no spontaneous recovery by 6 months, and biceps function is absent at 3 months. What is the recommended intervention, and why?

Answer 48

Surgical intervention, such as nerve grafts or transfers, is recommended to restore function, as lack of recovery by 6 months suggests severe nerve damage.

Question 49

During a Moro reflex test, an infant shows asymmetry, with one arm not abducting or extending. What does this indicate, and which nerve roots are likely involved?

Answer 49

This indicates BPI, likely involving the C5-C6 nerve roots (Erb’s Palsy).

Question 50

A patient with Global Palsy (C5-T1) presents with total arm paralysis and sensory loss. What is the prognosis, and what complicating factor might be present?

Answer 50

The prognosis is poor due to the extensive nerve involvement. Horner’s Syndrome may also complicate the case.

Question 51

A physical therapist observes a child with decreased ROM and difficulty with external shoulder rotation. What classification of BPI is most likely, and which muscles are affected?

Answer 51

Erb’s Palsy is most likely, with involvement of the deltoid, infraspinatus, and teres minor.

Question 52

A child presents with difficulty flexing the wrist and fingers but normal shoulder movement. Which classification of BPI is indicated, and what is the typical prognosis?

Answer 52

Klumpke’s Palsy is indicated. The prognosis is generally good, with many cases resolving within 6 months.

Question 53

During postural assessment, an infant exhibits asymmetrical thigh folds and limited hip abduction on one side. What does this suggest, and what additional tests should be performed?

Answer 53

This suggests developmental hip dysplasia (DDH), and additional tests like Ortolani and Barlow maneuvers should be performed.

Question 54

What sensory grading level corresponds to a patient with a reaction to painful stimuli but no reaction to touch in the affected limb?

Answer 54

The sensory grading level is S1.

Question 55

A child undergoing constraint-based therapy for BPI struggles to perform tasks with the affected limb. What additional interventions might enhance outcomes?

Answer 55

Electrical stimulation and sensory stimulation could enhance muscle activity and reintegration of the affected limb into functional tasks.