Congenital Diagnosis 3
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| Define brachial plexus injury. | Paralysis involving muscle of UE after mechanical trauma to the spinal roots of C5-T1 during birth. | |
| Which brachial plexus injury is most common? | Erb’s palsy. | |
| Which spinal segments are involved in Erb’s palsy? | C5/6. | |
| Which spinal segments are involved in Klumpke’s palsy? | C8/T1. | |
| Which spinal segments are involved in Erb-Klumpke’s palsy? | C5-T1. | |
| What are the four types of brachial plexus injuries? | Avulsion, rupture, stretch/neuropraxia, and neuroma. | |
| Define avulsion. | Nerve is completely torn from spine, requires surgery. | |
| Define rupture. | Nerve is completely torn, requires surgery. | |
| Define stretch/neuropraxia. | Nerve injured by not torn, most common. | |
| Define neuroma. | As nerve heals scar tissue develops around it and it can no long conduct signals due to pressure from scar. | |
| What are factors that contribute to brachial plexus injuries? | High infant birth weight, long labor, shoulder dystocia, breech, forceps delivery, traction. | |
| Forceful elevation and abduction of arm causes what type of brachial plexus injury? | Klumpke’s palsy. | |
| How is brachial plexus injury diagnosed? | MRI or EMG. | |
| Birth trauma resulting in brachial plexus injuries may also cause what problems? | Injury to facial nerve, fractures of clavicle or humerus, subluxation of shoulder, torticollis, damage to phrenic nerve. | |
| Nerve roots to C5/6 (Erb’s palsy) contribute to what peripheral nerves? | Suprascapular, nerve to subclavius, musculocutaneous, and axillary. | |
| Suprascapular nerve contributes to which muscles? | Supraspinatus, infraspinatus. | |
| The nerve to subclavius contributes to which muscles? | Subclavius. | |
| The musculocutaneous nerve contributes to which muscles? | Biceps, brachialis, and coracobrachialis. | |
| The axillary nerve contributes to which muscles? | Deltoid and teres minor. | |
| What is the characteristic position of Erb’s palsy? | Waiter’s tip: adduction, IR, elbow extension , forearm pronation, and wrist flexion. | |
| What are the typical clinical signs of Erb’s palsy? | Scapular winging due to damage to the LTN, loss of sensation down lateral side of arm, absence of reflexes on that side, absence of biceps and radial tendon reflexes, GRASP INTACT. | |
| What are the typical clinical signs of Klumpke's palsy? | Hand has clawed appearance due to loss of intrinsics, loss of sensation on medial aspect of arm. | |
| What is the treatment for brachial plexus injuries? | Rest for 7-14 days, partial immobilization, massage of limb, sensory input. | |
| What are the goals of treatment for brachial plexus injuries? | Maintain ROM, stimulate muscle function. |
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