Chapter Eighteen: Orthoses for Brachial Plexus Injuries

Question 1

What are the two types brachial plexus injuries?

Answer 1

Preganglionic

Postganglionic

Question 2

What is pregaglionic brachial plexus injury?

Answer 2

The root is avulsed directly from the spinal cord proximal to the dorsal root ganglion
Complete motor and sensory loss in the involved root and denervation of the deep paraspinal muscles of the neck have occured.

Question 3

What is postganglionic brachial plexus injury?

Answer 3

Avlused or injured distal the dorsal root ganglion, within the trunk, divisions, cords, or terminal branches.

Question 4

What is indicative of a C5 avulsion in a preganglionic injury?

Answer 4

Rhomboid paralysis

Question 5

What is indicative of a C5, C6, C7 avulsions in a preganglionic injury?

Answer 5

Serratus anterior paralysis

Question 6

What is indicative of a C8, T1 avulsions in a preganglionic injury?

Answer 6

Horner syndrome (ptosis, miosis, and anhidrosis, enophthalmos). 
ptosis: drooped lid
Miosis: constricted pupil
Anhidrosis: dry eyes
enophthalmos: sinking of the eyeball

Question 7

What is a common symptoms of brachial plexus injury?

Answer 7

Weakened supraspinatus muscle which leads to shoulder subluxation.

Question 8

What are the goals of orthoses for brachial plexus injuries?

Answer 8

Support the weight of the upper limb and ease traction forces on the shoulder

Question 9

What is the most readily avaliable device used for brachial plexus injuries?

Answer 9

A sling

Question 10

What is another orthosis that acts as an alternative to the sling for brachial plexus injuries?

Answer 10

The Hemisling

Question 11

What is the hemisling?

Answer 11

Consists of two small 4-6 inch crades attached by a long strap. One cradle holds the peoximal forearm and the other the wrist and hand.

Question 12

What is another possible orthosis for brachial plexus injury other than sling and hemisling?

Answer 12

Gunslinger splint

Question 13

What is the gunslinger splint?

Answer 13

A hip cap was attached by a belt on the waist and rested on the pelvic crest. A solid bar extended from the hip cap to the proximal forearm of the injured side. The bar could hold the humerus in neutral adduction or up to 45 degrees of abduction.

Question 14

What is another device that can be used for brachial plexus injuries other than the slings and gunslinger spint?

Answer 14

A shoulder cap.

Question 15

What is the shoulder cap?

Answer 15

The shoulder cap fits snugly over the acromioclavicular joint region and is held in palce by a strap that fits under the contralateral axilla. It can extend laterally over the deltoid or by a second strap under the ipsilateral axilla.

Question 16

Patients with C4-7 nerve root distributions exhibit weakness where?

Answer 16

The shoulder girdle musculature as well as the elbow joint.

Elbow flexion is more often affected then elbow extension.

Question 17

Patients with affected C7, C8, and T1 nerve root, usually have which movements preserved?

Answer 17

Wrist movement and elbow extension (triceps)

Question 18

Many cases of brachial plexopathy involve damage to the whole plexus resulting in what?

Answer 18

Flail arm

Question 19

What is the functional arm orthosis (FAO)?

Answer 19

It incorporates multiple controls for the shoulder, elbow, and terminal device. They are powered by the opposite shoulder

Question 20

If the patient has preservation of C7, what motion do they have?

Answer 20

Wrist extension

Question 21

What orthosis can be used for preservation of C7?

Answer 21

Tenodesis splint