CMT and Brachial Plexus Injury

Question 1

_ _ _ occurs when a baby is wedged off to the side in-utero with _ _.

Answer 1

Congenital Muscular Torticollis (CMT)

. . . With limited movement

Question 2

CMT is a _ _ detected at birth or shortly after, primarily due to _ shortening and _ of the _ muscle.

Answer 2

Postural deformity detected at birth or shortly after, primarily due to unilateral shortening and fibrosis of the SCM muscle

Question 3

Classic CMT head posture: _ _ of the head and neck _ the side of the impaired _, with _ of the _ away from the side of the impaired _. Sometimes?

Answer 3

Lateral tilt of the head and neck TOWARD the side of the impaired SCM

With rotation of the chin away from the side of the impaired SCM

Sometimes will have tilt and rotation in same direction

Question 4

If the right SCM is tight the child has _ Torticollis. If the SCM is not tight, Torticollis is labeled by?

Answer 4

Right SCM tight) = Right Torticollis

If not tight, Torticollis is labeled by the side of the head tilt

Question 5

Signs and symptoms of CMT: limited side bending? Limited rotation? _ head posture.

Answer 5

Limited side bending away from affected side

Limited rotation towards affected side

Asymmetrical head posture

Question 6

Signs and symptoms of CMT: compensatory _ and _ _ (non-rigid _), _ _ or _ in the body of the SCM muscle usually in the _ _. Typically resolves?

Answer 6

Compensatory cervical and thoracic scoliosis (non-rigid scoliosis)

Psuedo tumors or swelling in the body of the SCM muscle usually in the distal 1/3

Typically resolves itself, but tightness may remain

Question 7

What are 2 deformities that can be seen with CMT. Often?

Answer 7

Deformational plagiocephaly (skull deformity)

Facial Assymetry

Often parents biggest concern

Question 8

_ is highly correlated with CMT, percentage?

Answer 8

Plagiocephaly, occurs in approx. 75%

Question 9

3 causes of plagiocephaly: _ deformities, _ and _ syndromes.

Answer 9

Positional deformities

Craniosynostosis (premature closing of skull suture)

Craniofacial syndromes

Question 10

Physical examination documentation: _ _ position, _ and _ deformities, _/ _ of cervical spine, and _ of head off of _.

Answer 10

Resting head position
Plagiocephaly and facial asymmetries
AROM/ PROM of cervical spine
Degrees of head off of midline

Question 11

Normal ROM for a baby: cervical rotation? Lateral flexion of head?

Answer 11

Rotation: 90 degrees

Lat. Flexion: 60 degrees

Question 12

Physical Exam for CMT: screen for _ _ (_% with muscular Torticollis), evaluate _ and _ _ _.

Answer 12

Screen for hip dysplasia (14.9% associated with muscular Torticollis)

Evaluate reflexes and gross motor skills

Question 13

3 subgroups of CMT? Associated %?

Answer 13

SMT: palpable mass with the SCM- 47.2%

MT: SCM tightness but no mass- 30.5%

PosT:All features of MT without muscle tightness or tumor- 22.1%

Question 14

4 PT interventions for CMT

Answer 14

ROM
Positioning in prone
Handling (carrying in backpack/ baby bjorn instead of lying down)
Head righting reactions

Question 15

PT goal for CMT: restore complete neck _ _, reverse or stop progression of _ _, prevent _ and _ changes that may affect milestones due to _.

Answer 15

Restore complete neck ROM ASAP

Reverse or stop progression of skull deformity

Prevent bony and postural changes that may affect milestones due to Assymetry

Question 16

Orthosis or medical helmet, surgery to release tight SCM, and Botox are examples of?

Answer 16

Examples of medical interventions for CMT

Botox often only needs to be done once in order to eliminate tightness of the SCM

Question 17

Treatment of CMT in - _ range results in _ outcomes.

Answer 17

3-6 month range, results in excellent outcomes

Question 18

Brachial Plexus injuries often occur due to a _ _ and/ or _ to the shoulder or spine

Answer 18

Difficult delivery

Trauma to the shoulder or spine

Question 19

Shoulder dystocia, high birth weight, maternal diabetes and breech presentation are all?

Answer 19

Factors that increase incidence for brachial plexus injury

Question 20

With BPI: impairments are present _ _ _, inability to move _ _, presents _.

Answer 20

Are present immediately after birth, inability to move upper extremity, presents unilaterally

Question 21

Impairments associated with BPI: soft tissue _, _, abnormal _ and _ _, and _ developmental milestones.

Answer 21

Soft tissue contractures
Abnormal substitution and bone growth
Neglect
Asymmetrical developmental milestones

Question 22

2 palsies associated with BPI and affected nerve roots

Answer 22

Erb’s palsy
- C5-C7

Klumpke’s Palsy
- C7-T1

Question 23

Erb’s palsy presentation: shoulder in _, _, and _. Elbow _. Forearm _, and wrist and finger _.

Answer 23

Shoulder in extension, IR, and adduction

Elbow extended

Forearm pronated

Wrist and finger flexed

Question 24

3 types of BPI’s

Answer 24

Neuropraxia, Axonotmesis, and Neurotmesis

Question 25

_ is a “ stretch injury”; temporary nerve conduction _ with intact _.

Answer 25

Neuropraxia

Temporary nerve conduction block with intact axons

Question 26

_ has “sheath intact”, causes disruption of _ while neural sheath _ _

Answer 26

Axonotmesis

Causes disruption of axons while neural sheath remains intact

Question 27

_ is a “complete rupture” with _ of the nerve. _ fails without _ intervention

Answer 27

Neurotmesis

With severance of the nerve

Regeneration fails without surgical intervention

Question 28

_ is a fibrous mass of tissues. _ and _ can develop into. Sometimes requires?

Answer 28

Neuroma

Axonotmesis and Neurotmesis can develop into a neuroma

Sometimes requires surgery to repair

Question 29

Neural regeneration occurs at approximately _ _ per day.

Answer 29

1 mm

Question 30

Majority of recovery of nerves (regeneration) in BPI occurs in the upper arm? Lower arm? Continued recovery can occur up to?

Answer 30

Upper arm: 4-6 months

Lower arm: 7-9 months

Continued recovery: up to 24 months

Question 31

3 scales used to assess BPI

Answer 31

SAM

Sensation
Active movement scale for infants
Mallets functional scale

Question 32

With BPI: UE rests for? Instruct family on? (2)

Answer 32

Rests fro 7-10 days

Instruct family on ROM and positioning guidelines

Question 33

PT goal for BPI: support _ _, prevent _ _.

Answer 33

Support spontaneous recovery, and prevent secondary impairments

Question 34

PT intervention for BPI: facilitate normal _ _, stabilize _ _ while reaching, and _ of _ arm.

Answer 34

Facilitate normal movement

Stabilize scapula manually while reaching

Immobilization of unaffected arm

Question 35

Outcomes for BPI: Percentage full recovery, late recovery, and incomplete recovery. And time frame associated with each?

Answer 35

Full recovery:
-34%, several days to 3 weeks

Late recovery:
-32%, by 1 year

Incomplete recovery:
- 34% by age 3

Question 36

Recovery Windows for BPI: Upper arm? Lower arm?

Answer 36

Upper arm- 2 years

Lower arm- 4 years