Obstetric Brachial Plexus Injury Flashcards

1
Q

Erb’s Palsy

A

C5, C6, C7

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2
Q

Klumpke Palsy

A

C8, T1

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3
Q

Total Palsy

A

C5-T1

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4
Q

Shoulder Dystocia

A

A common occurrence in OBPI

Happens when shoulder butts up against pubis

Almost like an AC separation, but in a baby

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5
Q

Risk Factors

A

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

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6
Q

Typical presentation of Erb’s Palsy

A
Shoulder ADD and IR
Elbow extension
Forearm pronation
Wrist and finger flexion
Ulnar deviation or drift of wrist

“Waiter’s tip posture”

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7
Q

Neuropraxia

A

Physiologic block of nerve

Most common

Best for recovery of function

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8
Q

Avulsion

A

Nerve torn from the spine

Worst for recovery

Most need neurosurgery

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9
Q

Nerve ruptures

A

Axonotmesis
Neurotmesis
Neuroma

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10
Q

Axonotmesis

A

Anatomic disruption of axon with little disruption of connective tissue

Myelin is fine

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11
Q

Neurotmesis

A

Anatomic disruption of axon AND connective tissue (myelin)

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12
Q

Neuroma

A

Nerve torn and healed, but scar tissue surrounding the injury also limits nn conduction

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13
Q

Assessment

A

Narakas or Gilbert and Tassen System

Hospital for Sick Children Active Movement Scale

Mallet Classification

PROM and MMT

EMG

Functional Assessments - PEDI, Jebsen, Peabody

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14
Q

Obstetric Brachial Plexus Injury

A

Due to BP traction during birthing process

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15
Q

PT and OT

A
PROM (lots)
AROM
Stretching
Facilitation of use, strengthening
NMES, FES
Kinesiotaping
Forced use
Gross and Fine Motor Function, ADL's
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16
Q

Clarion posture

A

Limited ER

Similar to hands to heart’s center

ONE OF THE MOST LIMITED MOTIONS IN THESE CHILDREN

17
Q

Neurosurgery for Erb’s Palsy

A

FAIR outcome for reconnection and reconduction

18
Q

Last motions to come back

A

Supination of forearm and ER of shoulder

Arms OH, too

19
Q

Outcome???

A

Biceps out initially

Work up to elbow ext + supination

20
Q

3 mos of PT

A

If they don’t have biceps recovery, they should be referred for neurosurgery

21
Q

Horner’s Sign

A

Ptosis and tearing on side of OBPI

22
Q

Prognostic factors

A

No association with initial symptoms

No association with ethnic background or SES of the parents

23
Q

Eventual neurological recovery

A

Sup and ER best indicators at 3 mos for predicting neurological recovery

24
Q

Mean age of children as time of functional outcome assessment

A

3 years 10 mos

Demand for ADL function is minimal at that age

Likely that functional problems will increase with age