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