Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Torticollis and Brachial Plexus Injuries > Flashcards

Torticollis and Brachial Plexus Injuries Flashcards

1
Q

What is the associated muscle problem involved with CMT?

A

Unilateral shortening of the sternocleidomastoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the presentation for a child with CMT?

A
  • limited cervical ROM
  • laterally flexed toward the shortened muscle and rotated away

(ex: shortened R SCM, laterally flexed to R, rotated to L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the proposed etiology for CMT?

A

Delivery complications or how the baby is positioned in utero

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What babies are most at risk for developing CMT?

A

Breech babies, first born babies, babies that require instruments during delivery, heavier babies, babies born during complicated labor and delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What changes can be seen in the SCM for those with CMT?

A

A palpable mass or fibrotic tumor. Fibrosis of SCM is present in all children with CMT, mass may or may not be present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the hypothesized reason that the SCM is damaged during labor?

A

Occlusion to the blood vessels with resultant anoxic injury to SCM muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 types of CMT?

A
  • SCM Tumor
  • Muscular Torticollis (MT)
  • Positional Torticollis (POST)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe a SCM Tumor

A

A definitive mass or tumor is palpable within the SCM muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe MT

A

Contracture of the SCM is present but no palpable mass is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe POST

A

Contracture of the SCM muscle and a palpable mass are ABSENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some conservative methods of treating MT?

A
  • prolonged passive stretching of the SCM muscle
  • positioning and handling
  • active cervical ROM with strengthening exercises
  • symmetric development activities to correct head position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What orthotic device can be useful in treating MT?

A

A TOT collar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does the TOT do?

A

Elongates targeted muscles and limits motion in the opposite direction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is a TOT recommended?

A

For infants at least 4 months old with a consistent head tilt of 5 degrees or more for more than 80% of the day, who perform all movements with a head tilt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is surgery recommended for CMT?

A

For infants that don’t respond after 6 months of conservative treatment.
Have a residual head tilt and exhibit deficits of passive rotation and lateral flexion of the neck >15 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the term for infants with cranial-facial asymmetry?

A

Plagiocephaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does DOC stand for? Is it approved by the FDA?

A

Dynamic Orthotic Cranioplasty, it is approved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does the DOC work?

A

It’s a cranial band that applies pressure to the anterior and posterior prominences of the cranium but allows growth in the flattened areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who are DOC bands recommended for?

A

Between 3 and 4 and below 12 months of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long should a DOC band be worn?

A

23-24 hours a day initially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 2 other additional treatments that can be used for infants with plagiocephaly?

A

PT and Botox injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where do brachial plexus injuries occur?

A
  • rootlet attached to spinal cord
  • anterior or posterior rootlets
  • distal to rootlet attachment leaving vertebral canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

________ is a complete rupture of the nerve and nerve sheath.

A

Neurotmesis

neuro + tmesis=cut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

_______ is a disruption of the axons with the neural sheath intact.

A

Axonotmesis

axono + tmesis=cut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

_____ is a temporary nerve conduction block with intact axons.

A

Neurapraxia

neuro + praxia=from apraxia, uncoordinated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the prognosis for a brachial plexus injury? What is the regrowth rate for axons?

A

Depends on severity.
Regrowth = 1mm/day
UE = 4-6 months
LUE = 7-9 months

27
Q

What are the risk factors for brachial plexus birth palsies?

A
  • shoulder dystocia
  • maternal diabetes
  • difficult deliveries
28
Q

What occurs during shoulder dystocia?

A

The baby’s shoulder is caught on the mother’s pubic bone and is dislocated

29
Q

How can maternal diabetes lead to a brachial plexus injuries?

A

Mother has high glucose levels, brings extra glucose the baby, causes baby to put on extra weight

30
Q

What are some labor difficulties that can cause brachial plexus injuries?

A
  • breech birth (head is caught in birth canal)

- impacted shoulder (vacuum may be needed for extraction, can stretch nerves of brachial plexus)

31
Q

What are some of the negative effects that occur with traction during delivery?

A
  • injure cervical roots
  • fracture clavicle or humerus
  • sublux the shoulder
32
Q

Traction and rotation of the head tends to injure ______ roots.

A

C5 and C6

33
Q

What occurs with an injury to C4?

A

Less common- will cause ipsilateral hemiparesis of the diaphragm

34
Q

Infants with a birth weight over ____ lbs had a risk of BPI ___x greater of that of infants born less than ____ lbs.

A

9.9 lbs (4500 g)
45x
7.7 lbs (3500 g)

35
Q

What is the most important risk factor for developing a BPI?

A

Birth weight

36
Q

What is the most common presentation of BPI? What nerves are affected?

A

Upper roots of C5-C6

Erb’s Palsy

37
Q

What changes occur with Erb’s Palsy?

A 
Shoulder is held in EXT, IR, ADD
Elbow is extended
Forearm is pronated
Wrist and fingers are flexed
Grasp is intact, sensory loss may be present
38
Q

What occurs if C7 is invovled?

A

Elbow and finger extension are compromised

39
Q

What is Erb-Klumpke Palsy?

A

Combination of the injury to the upper and lower roots (C5-T1)

40
Q

What is the presentation of Erb-Klumpke Palsy?

A

Total arm paralysis and loss of sensation.

Unilateral involvement, pattern doesn’t always fit classic definitions indicating incomplete or mixed upper/lower types

41
Q

What syndrome is associated with Erb-Klumpke Palsy?

A

Horner’s Syndrome- deficient sweating, recession of eyeball (ptosis), abnormal pupillary contraction

42
Q

What is Klumpke’s Palsy?

A

Involves only lower roots of C7-T1

43
Q

What is affected in Klumpke’s Palsy?

A
  • shoulder and elbow movement are not impaired, resting position of forearm is in supination
  • paralysis of wrist flexors/extensors, and intrinsics of the wrist/hand
44
Q

What are the key observation/examination findings for Erb-Klumpke Palsy?

A
  • UE neglect
  • Soft tissue contractures
  • Abnormal bone growth
45
Q

What orthopedic abnormalities are noted with Erb-Klumpke Palsy?

A
  • Flattening of the humeral head
  • Shortened clavicle
  • Hypoplasia (hypo=under, plasia=formation) of the humeral head
  • Abnormal glenoid fossa
46
Q

What type of torticollis is associated with Erb-Klumpke Palsy? Why?

A

Positional Torticollis

Can develop if the head is habitually positioned away form the involved arm or may be present from same trauma

47
Q

What are the 3 main activities will a child with EKP be impaired with/unable to complete?

A

1) Reach
2) Grasp
3) Tasks involving bilateral manual abilities

48
Q

What changes can be present in a child with EKP in the following areas:

1) prone/supine to sit
2) creeping
3) mobility

A

1) may be done to one side, thereby asymmetrically strengthening one side of the trunk or delaying balance reactions
2) creeping on all 4’s may not occur
3) child may scoot in sitting or progress directly to walking

49
Q

What problems can result from sensory impairments associated with EKP?

A

Burns, insect bites and abrasions may go unnoticed

50
Q

What are the goals of management for a patient with EKP?

A

1) provide opportunity for adequate growth/development with a multidisciplinary approach
2) continued assessment of motor function return
3) possible activity limitations

51
Q

What types of neurosurgical interventions are available for patients with EKP?

A
  • nerve grafting
  • neuroma dissection and removal
  • neurolysis
  • direct end-to-end nerve anastomosis of the nerve ends
52
Q

Describe the active movement scale chart for BPI

A 
0= no contraction
1= contraction w/o movement
2= 1/2 ROM
4=full ROM (gravity eliminated)
5=1/2 ROM
7=full ROM
53
Q

Why may orthopedic surgery be an option for patients with BPI?

A

Contractures and deformities.

Shoulder ADD/IR, elbow flex/ext, forearm pronation

54
Q

What types of orthopedic surgical intervention are available for BPI?

A
  • Soft tissue releases
  • reduction of GH joint dislocations
  • transfers of muscles
  • osteotomies
55
Q

What is the prognosis for BPI?

A

Early studies report 80-90%

More recent report 66-73%

56
Q

What is the common presentation for a patient with a BPI?

A 
Decreased ER
IR contractures
Weak/limited should ABD
Scapular winging
Stronger IR
57
Q

What special test is specific to BPI? What other test is it best used with?

A

Brachial Plexus Outcome Measure

Active Movement Scale

58
Q

What does the Brachial Plexus Outcome Measure consist of?

A

Evaluates the UE movement with 11 movements. Graded on 5 point ORDINAL scale. Demonstrates good internal consistency and CONSTRUCT validity.

59
Q

What are the PT goals for a patient with a BPI?

A

Ideal Outcome: return of motor control and sensation without limitations

  • increase shldr ABD to >90 degrees
  • correct IR of arm
  • increase flex/ext against resistance in elbow, wrist, fingers
  • improve sensation in arm/hand
  • prevent deformities in arm/hand
  • achieve developmental milestones
60
Q

How long/why should a rest period be enforced before beginning any interventions after a BPI?

A

7-10 days to wait for swelling to go down

61
Q

Why are ROM and sensory interventions necessary in BPI?

A

ROM to prevent adhesions

Sensory awareness to reduce neglect

62
Q

How can splinting be beneficial is patients with a BPI?

A
  • can place UE in optimal position, promote soft tissue mobility
  • intermittent splinting can preserve tendons and reduce contractures
  • restraining splints can promote activity of involved limb
63
Q

What position should the arm with the BPI be placed in while splinting?

A

shoulder ABD and ER, elbow flexion and forearm supination

Pediatrics (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions