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Ortho Eval > Week 8 - Obstetrical Brachial Plexus Injuries > Flashcards

Week 8 - Obstetrical Brachial Plexus Injuries Flashcards

1
Q

how is obstetrical brachial plexus palsy defined?

A

defined as a flaccid paresis of an UE due to traumatic stretching of the brachial plexus received at birth, with the PROM greater than the AROM

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2
Q

obstetrical brachial plexus palsy results from injury to which parts of brachial plexus?

A
  • cervical roots C5-C8

- thoracic root T1

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3
Q

what % of individuals with obstetrical brachial plexus palsy have recover spontaneously?

A

70%-92%

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4
Q

describe 2 aspects of the pathophysiology of obstetrical brachial plexus injury.

A
  • excessive traction applied to nerves

- intrauterine maladaptation

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5
Q

name 3 causes of excessive traction applied to nerves in OBP injury.

A
  • shoulder dystocia
  • use of excessive or misdirected traction
  • hyperextension of the arms in breech extraction
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6
Q

name 3 neonatal risk factors of OBP.

A
  • high birth weight (>8.8 lbs)
  • fetal position - breech
  • poor tone
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7
Q

birth weight is strongly associated with what?

A

increased risk of shoulder dystocia

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8
Q

name 3 maternal risk factors of OBP.

A
  • diabetes/obesity/excessive weight gain
  • maternal age (>35 years)
  • maternal pelvic anatomy
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9
Q

name 3 labor-related risk factors

A
  • shoulder dystocia
  • prolong duration of labor
  • the mode of delivery
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9
Q

anterior shoulder impacted behind pubic synthesis

A

shoulder dystocia

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10
Q

describe the severity of OBP classifications in order of most severe to least severe.

A
  • avulsion
  • neurotmesis
  • axonotmesis
  • neurapraxia
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11
Q

which roots of the BP are affected if it is classified as “upper?”

A

C5, C6 and sometimes C7

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12
Q

which roots of the BP are affected if it is classified as “intermediate?”

A

C7 and sometimes C8, T1

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13
Q

which roots of the BP are affected if it is classified as “lower?”

A

C8 and T1

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14
Q

what is an upper BP injury also known as?

A

Erb’s Palsy

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15
Q

what is a lower BP injury also known as?

A

Klumpke paralysis

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16
Q

name the 4 anatomical classifications of BP.

A
  • upper/Erb’s Palsy
  • intermediate
  • lower/Klumpke paralysis
  • total
17
Q

describe UIAs of Group I BP injuries.

A
  • shoulder abduction/external rotation

- elbow flexion

18
Q

name the 4 clinical/Narakas classifications of BP injuries.

A
  • Group I - C5,C6
  • Group II - C5-C7
  • Group III - C5-C8, T1
  • Group IV - C5-C8, T1
19
Q

describe UIAs of Group II BP injuries.

A
  • shoulder abduction/external rotation
  • elbow flexion
  • drop wrist
20
Q

describe UIAs of Group III BP injuries.

A

complete flaccid paralysis

21
Q

describe UIAs of Group IV of BP injuries.

A

complete flaccid paralysis with Horner’s Syndrome

22
Q

most severe form; all nerves pulled out of cord

23
Q

why is poor muscle tone a risk factor?

A

not enough force to come out or turn positions

24
rupture/tear - surgical repair possible
neurotmesis
25
most mild form
neurapraxia
26
what is the typical arm position of OBP?
usually flexed position
27
is full ROM in babies good?
no not a good sign - flexor tone typically dominates at this time
28
name 4 clinical features of OBP.
- arm position - flexed - local pain - ROM - full ROM - reflexes impaired - grasp, ATNR, moro
29
which types of movements indicate abnormalities?
asymmetrical movements
30
checklist, ask kids to do certain UE movements
Mallet classification
31
name 2 treatment principles in the acute stage of OBP.
- prevent further damage to traumatized structures (swelling) - prevent contractures of the involved joints
32
Name 6 aspects of conservative treatment (avoidance of surgery) of OBP.
- ROM exercises - positioning/handling - splinting - kinesiotaping - therapeutic activities - E. stim - home programs - be aware of compensatory movements
33
which ROM exercises are used in conservative treatments of OBP?
scapula stabilization - lie pt. on back and raise arm overhead
34
name 4 splints used for OBP treatment.
- resting hand splint - dynamic - Smith Roylan TPA splint - air splint
35
name 3 therapeutic activities used to treat OBP.
- strengthening exercises - weight bearing via developmental positions - sensory stimulation to increase awareness of affected side
36
name 3 therapeutic activities used to treat OBP.
- strengthening exercises - weight bearing via developmental positions - sensory stimulation to increase awareness of affected side
37
name 2 criteria for surgical intervention for OBP.
- lack of biceps function by 3 months of age | - complete injury with Horner's syndrome with no recovery at 1 month of age
38
name 2 types of surgical interventions used to treat OBP.
- nerve grafts and nerve transfers | - muscle transfer
39
by 3 months of age, if there is no biceps movement, they will consider doing what type of surgery?
nerve repair

Ortho Eval (24 decks)

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