Obstetrical Brachial Plexus Palsy Flashcards
how do you define obstetrical prachial plexus palsy?
flaccid paresis of UE due to trauma of C5-C8, T1 received at birth
PROM greater than AROM
what is the cause of congenital BPI?
high uteral pressure b/c low tone babies cant push themselves out of womb
what can cause susceptibility to BPI?
congenital muscular disorder
What is the mechanism that causes BPI?
- excessive traction (MD) due to excessive misdirected traction, hyperext of arms in breech extraction
- intrauterine maladaption
what is breech extraction?
legs come out first
What are neonatal risk factors of BPI?
high birth weight >12 lbs
breech delivery
poor tone
what are maternal risk factors of BPI?
dm, OBESITY
>35 Y/O
narrow pelvis
what are labor related risk factors of BPI?
Shoulder Dystocia
added pressure prolonged duration of labor
forceps puts pressure on shoulder
what occurs during normal delivery?
head hyperextends around pubic symphisis
what is an avulsion?
n. pulled out from root (worst)
what is a rupture?
BP breaks in an area during tractoin
what is a neuroma?
repair with scar tissue which can influence conduction
what is a neuropraxia?
n. irritated & area is swollen but sheath intact (mild, most common)
what is the classification of BPI?
group 1 = C5-C6: shoulder + biceps
group 2 = C5-C7: shoulder + biceps + forearm
group 3 = C5-T1: complete limb paralysis
group 4 = C5-T1: (Horner’s)
what is Erb’s Palsy?
C5-C7
what is Klumpke Paralysis?
C8-T1
problems with wrist + hand
what is Horner’s syndrome?
preganglion sensory root avulsed
thoracic n. damage maybe phrenic
pupil dilation, eyelid control
breathing problems
what things does BPI affect?
arm position
local pain
ROM
reflexes
what is don during acute stage BPI?
prevent further damage
prevent contracture
positioning
when to reassess?
after 1 month check to see if biceps are working
after 2 years muscle transfer
what are conservative management techniques used?
scap stabilization positioning (use other arm for normal range) splinting strengthening + weightbearing E stim avoid compensatory movements
motor learning for BPI
mimic normal baby movements to facilitate muscle action
what is the criteria for surgery?
lack biceps fx by 3 months
complete injury with horners syndrome (no recovery at 1 month)
