Brachial Plexus Injury 2024 PDF

BRACHIAL PLEXUS INJURY DZALANI HARUN (PhD) NNK3132- PEDIATRIC BRACHIAL PLEXUS INJURY  Brachial plexus is a weakness or paralysis involving the muscles of the UE as a result of injury to the group of nerves that supply the arms and hands.  Injuries are transient with full return...

BRACHIAL PLEXUS INJURY DZALANI HARUN (PhD) NNK3132- PEDIATRIC BRACHIAL PLEXUS INJURY  Brachial plexus is a weakness or paralysis involving the muscles of the UE as a result of injury to the group of nerves that supply the arms and hands.  Injuries are transient with full return of function occurring in 70 – 92% of cases (Plas Reconstruction Surgery 2994; 93: 675-80) INCIDENCE ANATOMY OF BRACHIAL PLEXUS A network of nerves running from the cervical spinal cord in the neck to the shoulder, arm and hand. CAUSES  Foetal Macrosomia (≥ 4kg) Breech  Maternal Diabetes in pregnancy Shoulder dystocia (one of the shoulders becomes stuck behind the mother's pubic bone) Small stature/cephalopelvic disproportion Primi or multiparity Prolong second stage of labour Greek words “dys,” (difficult) + “tokos,” (birth). Is a rare condition. Occurrence, 0.6% to 1.4% of babies weighing between 5 lb, 8 oz and 8 lb, 13 oz at birth. The rate increases to 5% to 9% of babies born weighing more than 8 lb, 13 oz. Vacuum Extractor delivery Forceps delivery Classification- severity Classification of Brachial Plexus Injury I C5, C6: paralysis of shoulder, and elbow flexors Erb-Duchenne , Waiter’s tip position” 90% spontaneous recovery II C5, C6, C7: paralysis of shoulder, and elbow flexion, pronation/ supination, wrist drop, and altered hand sensation 60% spontaneous recovery III C5, C6, C7, C8, T1: total paralysis 40% spontaneous recovery Nerve repair/muscle transplant mitigate disability IV Severe damage and sympathetic injury Klumke’s, claw hand Full spontaneous recovery not seen Surgery to attempt to mitigate situation From Gilbert A and Tassin JL  ERB PALSY  Results from stretching of the 5th and 6th cervical nerves.  The infant ‘s arm is held in the ‘waiter’s tip’ position.  Arm extended and in internally rotated and the wrist flexed.  Erbs palsy should be suspected when Moro reflex is absent in the R+ arm and the R+ hand grasp is intact,  90% of these lesions resolve spontaneously by 4mths of age, but if the deficits persists, nerve grafting maybe beneficial.  Erb- Duchenne palsy Injury to Superior part of Plexus. Occurrence: Due to excessive increase in the angle between neck and the shoulder. Roots Involved: ➔ C5 and C6 Muscles Involved: ➔ Shoulder ➔ Arm  Erb- Duchenne palsy Clinical Appearance: Motor Loss: ➔ Adducted Shoulder ➔ Medially Rotated Arm ➔ Extended Elbow Sensory Loss: Lateral aspect of Upper Limb (uncommon) Waiter’s tip position  Characteristic position - adduction and internal rotation of the arm with forearm pronated  Forearm extension normal  Biceps reflex absent klumpke paralysis or Palsy Injury to Inferior part of Plexus. Occurrence/Etiology: Excessive abduction of arm (hyper-abduction traction). Less common then Injury to Superior part of Plexus. Roots Involved: ➔ C8 and T1 klumpke paralysis or Palsy Clinical Appearance: Motor Loss: ➔ Small muscles of Hand Sensory Loss: ➔ Medial aspect of Upper Limb Baby’s upper limb is pulled excessively during delivery Sign & Symptoms  Weakness and loss of movement of the forearm and hand. Horner syndrome can be present.  The infant with a nerve injury to the lower plexus (C8-T1) holds the arm supinated, with the elbow bent and the wrist extended.  There is a decreased grip on the affected side.  Sensory loss is difficult to assess in newborns.  Reflexes in the affected roots are absent. Claw Hand In older child claw hand may be noted. The wrist is kept in extension [unopposed force of wrist extensors due to loss of flexors], there is a hyperextension of metacarpophalangeal joint and flexion of interphalangeal joints due to loss of intrinsic muscles of the hand. (muscles atrophy and tightening)  TREATMENT  Surgery, tendon transfer  Occupational therapy  Hydrotherapy (water) Muscle strengthening and flexibility exercises  Medication Nerve graft  Physical therapy https://www.slideshare.net/AsirJohnSamuel/obstetric-brachial-plexus-injury-obpi?next_slideshow=14201416 TREATMENT