Torticollis/Brachial Plexus Injury Flashcards
How is the infant’s head positioned when they have torticollis?
Laterally flexed to the affected side, chin rotated to the opposite side
What can torticollis be caused by?
-Extrinsic: intrauterine constraint -Intrinsic: fetal hypomobility due to nervous system disorder -Breech, first-born, instruments during delivery, increased baby weight, complicated labor and delivery
What are the 3 types of CMT?
SCM tumor (palpable mass) Muscular torticollis (SCM contracture) Positional torticollis (neither)
When is a TOT collar recommended?
infant is at least 4 mo old with consistend head tilt of 5 degrees or more for >80% of day
When is surgical treatment recommended for babies with torticollis?
no response after 6 mo of conservative management + > 15 degrees passive ROM
What is commonly used to treat plagiocephaly and what does it do?
Dynamic Orthotic Cranioplasty (DOC) band: applies pressure to anterior and posterior prominences but allows growth in flattened areas (3/4 months - 12 months)
What is neurotmesis?
complete rupture
What is axonotmesis?
disruption of the axons with intact neural sheath
What is neuropraxia?
temporary nerve conduction block with intact axons
How quickly does a nerve regenerate? UE? Lower UE?
1 mm / day 4-6 months for UE 7-9 months for lower arm
What are the risk factors for Brachial Plexus Birth Palsy?
- Shoulder dystocia - Maternal diabetes - Difficult Deliveries
Infants over ______ lbs are ______x more likely does have brachial plexus birth palsy
9.9 lbs 45 x
What types of injuries to breech birth tend to cause?
- injuries to C5-C6 nerve roots (if C4 also… hemiparesis of the diaphragm) - clavicle or humerus fracture, shoulder subluxation
What nerve roots are damaged in Erb’s Palsy?
C5-C6
What nerve roots are damaged in Klumpke’s Palsy?
C7-T11
How is the UE held in a patient with Erb’s Palsy?
Shoulder extension, IR, and adduction Elbow extended, forearm pronated Wrist and fingers flexed (Waiter’s Tip)
How is the UE held in a patient with Klumpke’s Palsy?
Forearm resting in supination Paralysis of wrist flexion and extension, intrinsic hand muscles
What is Horner’s Syndrome?
deficient sweating, recession of eyeball, abnormal pupillary contraction
What are some observational presentations of Erb-Klumpke Palsy?
UE neglect, soft tissue contractures, abnormal bone growth
What are some orthopedic abnormalities associated with Erb-Klumpke Palsy?
flattening of humeral head, shortened clavicle, hypoplasia of humeral head, abnormal glenoid fossa
What are some special tests used to diagnose and track brachial plexus birth palsy?
Brachial Plexus Outcome Measure Active Movement Scale
How long do you wait after you suspect a brachial plexus birth injury and why?
7-10 days to see if swelling/hematoma resolve and the condition is transient
How do you splint a patient with brachial plexus birth palsy?
shoulder abduction and ER elbow flexion forearm supination
