Obstetrical Brachial Plexus Palsy

Question 1

how do you define obstetrical prachial plexus palsy?

Answer 1

flaccid paresis of UE due to trauma of C5-C8, T1 received at birth
PROM greater than AROM

Question 2

what is the cause of congenital BPI?

Answer 2

high uteral pressure b/c low tone babies cant push themselves out of womb

Question 3

what can cause susceptibility to BPI?

Answer 3

congenital muscular disorder

Question 4

What is the mechanism that causes BPI?

Answer 4

1. excessive traction (MD) due to excessive misdirected traction, hyperext of arms in breech extraction
2. intrauterine maladaption

Question 5

what is breech extraction?

Answer 5

legs come out first

Question 6

What are neonatal risk factors of BPI?

Answer 6

high birth weight >12 lbs
breech delivery
poor tone

Question 7

what are maternal risk factors of BPI?

Answer 7

dm, OBESITY
>35 Y/O
narrow pelvis

Question 8

what are labor related risk factors of BPI?

Answer 8

Shoulder Dystocia
added pressure prolonged duration of labor
forceps puts pressure on shoulder

Question 9

what occurs during normal delivery?

Answer 9

head hyperextends around pubic symphisis

Question 10

what is an avulsion?

Answer 10

n. pulled out from root (worst)

Question 11

what is a rupture?

Answer 11

BP breaks in an area during tractoin

Question 12

what is a neuroma?

Answer 12

repair with scar tissue which can influence conduction

Question 13

what is a neuropraxia?

Answer 13

n. irritated & area is swollen but sheath intact (mild, most common)

Question 14

what is the classification of BPI?

Answer 14

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)

Question 15

what is Erb’s Palsy?

Answer 15

C5-C7

Question 16

what is Klumpke Paralysis?

Answer 16

C8-T1

problems with wrist + hand

Question 17

what is Horner’s syndrome?

Answer 17

preganglion sensory root avulsed
thoracic n. damage maybe phrenic
pupil dilation, eyelid control
breathing problems

Question 18

what things does BPI affect?

Answer 18

arm position
local pain
ROM
reflexes

Question 19

what is don during acute stage BPI?

Answer 19

prevent further damage
prevent contracture
positioning

Question 20

when to reassess?

Answer 20

after 1 month check to see if biceps are working

after 2 years muscle transfer

Question 21

what are conservative management techniques used?

Answer 21

scap stabilization
positioning (use other arm for normal range)
splinting
strengthening + weightbearing
E stim
avoid compensatory movements

Question 22

motor learning for BPI

Answer 22

mimic normal baby movements to facilitate muscle action

Question 23

what is the criteria for surgery?

Answer 23

lack biceps fx by 3 months

complete injury with horners syndrome (no recovery at 1 month)