Week 8 - Obstetrical Brachial Plexus Injuries Flashcards
how is obstetrical brachial plexus palsy defined?
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
obstetrical brachial plexus palsy results from injury to which parts of brachial plexus?
- cervical roots C5-C8
- thoracic root T1
what % of individuals with obstetrical brachial plexus palsy have recover spontaneously?
70%-92%
describe 2 aspects of the pathophysiology of obstetrical brachial plexus injury.
- excessive traction applied to nerves
- intrauterine maladaptation
name 3 causes of excessive traction applied to nerves in OBP injury.
- shoulder dystocia
- use of excessive or misdirected traction
- hyperextension of the arms in breech extraction
name 3 neonatal risk factors of OBP.
- high birth weight (>8.8 lbs)
- fetal position - breech
- poor tone
birth weight is strongly associated with what?
increased risk of shoulder dystocia
name 3 maternal risk factors of OBP.
- diabetes/obesity/excessive weight gain
- maternal age (>35 years)
- maternal pelvic anatomy
name 3 labor-related risk factors
- shoulder dystocia
- prolong duration of labor
- the mode of delivery
anterior shoulder impacted behind pubic synthesis
shoulder dystocia
describe the severity of OBP classifications in order of most severe to least severe.
- avulsion
- neurotmesis
- axonotmesis
- neurapraxia
which roots of the BP are affected if it is classified as “upper?”
C5, C6 and sometimes C7
which roots of the BP are affected if it is classified as “intermediate?”
C7 and sometimes C8, T1
which roots of the BP are affected if it is classified as “lower?”
C8 and T1
what is an upper BP injury also known as?
Erb’s Palsy
what is a lower BP injury also known as?
Klumpke paralysis
name the 4 anatomical classifications of BP.
- upper/Erb’s Palsy
- intermediate
- lower/Klumpke paralysis
- total
describe UIAs of Group I BP injuries.
- shoulder abduction/external rotation
- elbow flexion
name the 4 clinical/Narakas classifications of BP injuries.
- Group I - C5,C6
- Group II - C5-C7
- Group III - C5-C8, T1
- Group IV - C5-C8, T1
describe UIAs of Group II BP injuries.
- shoulder abduction/external rotation
- elbow flexion
- drop wrist
describe UIAs of Group III BP injuries.
complete flaccid paralysis
describe UIAs of Group IV of BP injuries.
complete flaccid paralysis with Horner’s Syndrome
most severe form; all nerves pulled out of cord
avulsion
why is poor muscle tone a risk factor?
not enough force to come out or turn positions
rupture/tear - surgical repair possible
neurotmesis
most mild form
neurapraxia
what is the typical arm position of OBP?
usually flexed position
is full ROM in babies good?
no not a good sign - flexor tone typically dominates at this time
name 4 clinical features of OBP.
- arm position - flexed
- local pain
- ROM - full ROM
- reflexes impaired - grasp, ATNR, moro
which types of movements indicate abnormalities?
asymmetrical movements
checklist, ask kids to do certain UE movements
Mallet classification
name 2 treatment principles in the acute stage of OBP.
- prevent further damage to traumatized structures (swelling)
- prevent contractures of the involved joints
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
which ROM exercises are used in conservative treatments of OBP?
scapula stabilization - lie pt. on back and raise arm overhead
name 4 splints used for OBP treatment.
- resting hand splint
- dynamic
- Smith Roylan TPA splint
- air splint
name 3 therapeutic activities used to treat OBP.
- strengthening exercises
- weight bearing via developmental positions
- sensory stimulation to increase awareness of affected side
name 3 therapeutic activities used to treat OBP.
- strengthening exercises
- weight bearing via developmental positions
- sensory stimulation to increase awareness of affected side
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
name 2 types of surgical interventions used to treat OBP.
- nerve grafts and nerve transfers
- muscle transfer
by 3 months of age, if there is no biceps movement, they will consider doing what type of surgery?
nerve repair
