Torticollis/Brachial Plexus Injury

Question 1

How is the infant’s head positioned when they have torticollis?

Answer 1

Laterally flexed to the affected side, chin rotated to the opposite side

Question 2

What can torticollis be caused by?

Answer 2

-Extrinsic: intrauterine constraint -Intrinsic: fetal hypomobility due to nervous system disorder -Breech, first-born, instruments during delivery, increased baby weight, complicated labor and delivery

Question 3

What are the 3 types of CMT?

Answer 3

SCM tumor (palpable mass) Muscular torticollis (SCM contracture) Positional torticollis (neither)

Question 4

When is a TOT collar recommended?

Answer 4

infant is at least 4 mo old with consistend head tilt of 5 degrees or more for >80% of day

Question 5

When is surgical treatment recommended for babies with torticollis?

Answer 5

no response after 6 mo of conservative management + > 15 degrees passive ROM

Question 6

What is commonly used to treat plagiocephaly and what does it do?

Answer 6

Dynamic Orthotic Cranioplasty (DOC) band: applies pressure to anterior and posterior prominences but allows growth in flattened areas (3/4 months - 12 months)

Question 7

What is neurotmesis?

Answer 7

complete rupture

Question 8

What is axonotmesis?

Answer 8

disruption of the axons with intact neural sheath

Question 9

What is neuropraxia?

Answer 9

temporary nerve conduction block with intact axons

Question 10

How quickly does a nerve regenerate? UE? Lower UE?

Answer 10

1 mm / day 4-6 months for UE 7-9 months for lower arm

Question 11

What are the risk factors for Brachial Plexus Birth Palsy?

Answer 11

• Shoulder dystocia - Maternal diabetes - Difficult Deliveries

Question 12

Infants over ______ lbs are ______x more likely does have brachial plexus birth palsy

Answer 12

9.9 lbs 45 x

Question 13

What types of injuries to breech birth tend to cause?

Answer 13

• injuries to C5-C6 nerve roots (if C4 also… hemiparesis of the diaphragm) - clavicle or humerus fracture, shoulder subluxation

Question 14

What nerve roots are damaged in Erb’s Palsy?

Answer 14

C5-C6

Question 15

What nerve roots are damaged in Klumpke’s Palsy?

Answer 15

C7-T11

Question 16

How is the UE held in a patient with Erb’s Palsy?

Answer 16

Shoulder extension, IR, and adduction Elbow extended, forearm pronated Wrist and fingers flexed (Waiter’s Tip)

Question 17

How is the UE held in a patient with Klumpke’s Palsy?

Answer 17

Forearm resting in supination Paralysis of wrist flexion and extension, intrinsic hand muscles

Question 18

What is Horner’s Syndrome?

Answer 18

deficient sweating, recession of eyeball, abnormal pupillary contraction

Question 19

What are some observational presentations of Erb-Klumpke Palsy?

Answer 19

UE neglect, soft tissue contractures, abnormal bone growth

Question 20

What are some orthopedic abnormalities associated with Erb-Klumpke Palsy?

Answer 20

flattening of humeral head, shortened clavicle, hypoplasia of humeral head, abnormal glenoid fossa

Question 21

What are some special tests used to diagnose and track brachial plexus birth palsy?

Answer 21

Brachial Plexus Outcome Measure Active Movement Scale

Question 22

How long do you wait after you suspect a brachial plexus birth injury and why?

Answer 22

7-10 days to see if swelling/hematoma resolve and the condition is transient

Question 23

How do you splint a patient with brachial plexus birth palsy?

Answer 23

shoulder abduction and ER elbow flexion forearm supination