Congenital brachial plexus paralysis Flashcards
about brachial plexus
a peripheral nerve network responsible for the sensory, motor, and sympathetic innervations of upper extremities from spinal cord
obstetric brachial plexus paralysis
a flaccid paralysis mostly seen in one arm after injury in BP during delivery
risk factors for OBPP
**high birth weight
**prolonged birth
**interventional birth
**over 40 years
**macrosomia
**use of delivery assistive devices
problems caused by OBPP
fracture ** clavicle, humerus
SCM hematoma
Horner’s syndrome
shoulder dislocation
ceptial hematoma
neurological hematoma
confused as OBPP but are not
clavicle fracture
proximal humerus fracture
infection of glenohumeral joint
intrauterine radial nerve compression
types of OBPP
Duchenne Erb BPP [upper BPP]
upper middle
Klumpke’s palsy [lower BPP]
total BPP
Erb Duchenne
**common
**C5-C6
**sometimes C7
**no arm flexion and abduction
**infraspinatus, supraspinatus, biceps, deltoid and brachioradialis are affected
**biceps radial and Moro reflexes are absent
Klumpke’s paralysis
**C8-T1
**forearm flexors, intrinsic muscles of hand, finger extensors and wrist flexors are affected
**sensory deficiency on the medial side of the arm
**grasp reflex is absent
**drop wrist and claw hand
**Horner’s syndrome
Edematous finger ie cannot hold objects with fingers
total plexus paralysis
**C5-T1
**flaccid paralysis
**sensory defect
**no reflex
**motionless muscles
**Horner’s syndrome
Horner’s syndrome
a disease caused by damage to the upper cervical sympathetic nerve supply and C8-T1
**respiratory problems due to phrenic nerve injury
Intrinsic muscles weakness
Miosis,ptosis and anhidrosis
symptoms of HS
flask upper extremities
extended elbow
motionless arm
early signs of OBPP
inability to move both arms equally
discolorations
softness
no palmar reflexes
difficult holding
inability to make fist
no grasp
unilateral swelling on clavicle
signs that conservative treatment will fail
Horner’s syndrome with paralysis
dorsal scapula nerve involvement
sensory nerve involvement
total involvement
Signs that Conservative treatment of OBPP will work
Spontaneous recovery
Isolated upper trunk lesion
Muscle strength assessment in CBPP
Active movement scale
A 7-muscle system
Active M.S scoring when G is eliminated
0=no contraction
1..contraction
2…mvmnt less than half of the range
3…movement more than half the range
4…full movement
Against gravity scoring
- Movement less than half the Rom
- Movement more than half the Rom
- Full motion
Sensory evaluation on BPP
- No response to painful or other stimulus
- Reaction to painful stimulus
- Reaction to touch
- Almost Normal
Classification used in assessment of the shoulder
Mallet classification
Aim of early approach
Correct positioning
Care
Prohibitions
Why arm is rest for 2 weeks after birth
Due to,
Edema
Possible bleeding in the nerve surrounding tissues
What to avoid in 1st month
Traction
Lying on affected side
Passive shoulder joint movements
Hanging the arm down and swinging
Avoid statue of liberty position (ER)
Rehab after nerve repair
Early protection
Exercise
Splinting
Family education
Periodic evaluations
Aim of tendon transfer osteotomy
Increase ER
