obstetric brachial plexus

Question 1

incidence

Answer 1

occurs in around every 2 in 1000 vaginal deliveries

Question 2

risk factors

Answer 2

large babies (macrosomia), twin delivers and shoulder dystonia where there is trouble delivering the shoulder after the head and it becomes compressed on the pubic symphysis

Question 3

most common type of obstetric brachial plexus

Answer 3

ERBS palsy

Question 4

ERBS palsy

Answer 4

is damage to the C5 and C6 nerve roots causing motor nerve paralysis to the:

• BICEPS, BRACHIALIS AND CORACHOBRACHIALIS THROUGH THE MUSCULOCUTANEOUS NERVE
• BRACHIORADIALIS THROUGH THE RADIAL NERVE
• DELTOID THROUGH THE AXILLARY NERVE

Question 5

ERBS palsy causes

Answer 5

internal rotation of the humerus and the classic waiter tip position where the elbow is extended, forearm pronated and the wrist is flexed

Question 6

management of ERBS palsy

Answer 6

• physiotherapy should be started as soon as possible and if motor innervation returns by 6 months then has an extremely good outcome
• surgery is required if there is no response to physio by this time

Question 7

klumpkes palsy

Answer 7

caused by damage to the C8 and T1 nerve roots which results in paralysis of the intrinsic muscles of the hand and the flexors of the wrist specifically flexor carpi ulnaris and ulnar half of the flexor digitorum produndus

Question 8

klumpkes palsy causes

Answer 8

a clawed hand

Question 9

klumpkes palsy has a

Answer 9

worse prognosis than erbs palsy as there is no specific treatment

Question 10

klumpkes palsy can also cause

Answer 10

horners syndrome due to damage of the first sympathetic ganglia at T1