Obstetric Brachial Plexus Injury Flashcards
Erb’s Palsy
C5, C6, C7
Klumpke Palsy
C8, T1
Total Palsy
C5-T1
Shoulder Dystocia
A common occurrence in OBPI
Happens when shoulder butts up against pubis
Almost like an AC separation, but in a baby
Risk Factors
Large size baby (diabetic moms)
Breech delivery
Mother with many previous deliveries
Maternal obesity
Prolonged second stage of labor
Prolonged pregnancy
Maternal diabetes
Midpelvic operative delivery
Vacuum or forceps delivery
Typical presentation of Erb’s Palsy
Shoulder ADD and IR Elbow extension Forearm pronation Wrist and finger flexion Ulnar deviation or drift of wrist
“Waiter’s tip posture”
Neuropraxia
Physiologic block of nerve
Most common
Best for recovery of function
Avulsion
Nerve torn from the spine
Worst for recovery
Most need neurosurgery
Nerve ruptures
Axonotmesis
Neurotmesis
Neuroma
Axonotmesis
Anatomic disruption of axon with little disruption of connective tissue
Myelin is fine
Neurotmesis
Anatomic disruption of axon AND connective tissue (myelin)
Neuroma
Nerve torn and healed, but scar tissue surrounding the injury also limits nn conduction
Assessment
Narakas or Gilbert and Tassen System
Hospital for Sick Children Active Movement Scale
Mallet Classification
PROM and MMT
EMG
Functional Assessments - PEDI, Jebsen, Peabody
Obstetric Brachial Plexus Injury
Due to BP traction during birthing process
PT and OT
PROM (lots) AROM Stretching Facilitation of use, strengthening NMES, FES Kinesiotaping Forced use Gross and Fine Motor Function, ADL's
Clarion posture
Limited ER
Similar to hands to heart’s center
ONE OF THE MOST LIMITED MOTIONS IN THESE CHILDREN
Neurosurgery for Erb’s Palsy
FAIR outcome for reconnection and reconduction
Last motions to come back
Supination of forearm and ER of shoulder
Arms OH, too
Outcome???
Biceps out initially
Work up to elbow ext + supination
3 mos of PT
If they don’t have biceps recovery, they should be referred for neurosurgery
Horner’s Sign
Ptosis and tearing on side of OBPI
Prognostic factors
No association with initial symptoms
No association with ethnic background or SES of the parents
Eventual neurological recovery
Sup and ER best indicators at 3 mos for predicting neurological recovery
Mean age of children as time of functional outcome assessment
3 years 10 mos
Demand for ADL function is minimal at that age
Likely that functional problems will increase with age
