Pediatric Rehabilitation Lecture Series: Management of Brachial Plexus Injury (enduring material)-Lecture Handout

Lecture Handout

Pdf Summary

The document outlines the management of brachial plexus palsy (BPP) in infants, focusing on risk factors, types of injuries, diagnostic procedures, and treatment protocols. <br /><br />**Risk Factors**:<br />- **Maternal**: Gestational diabetes, previous difficult delivery.<br />- **Antenatal**: Large for gestational age (LGA), macrosomia, breech.<br />- **Peripartum**: Mechanical extraction, shoulder dystocia, hypoxia.<br />- Higher risk demographics include female, Black, and Hispanic infants, with macrosomia and LGA more prevalent in white infants.<br /><br />**Injury Types and Recovery**:<br />- **BPP Injury Zones**:<br />  - C5: Shoulder abduction and external rotation.<br />  - C6: Elbow flexion.<br />  - C7: Elbow extension.<br />  - C8: Wrist and finger extension.<br />  - T1: Finger flexion and intrinsics.<br />  <br />**Injury Classifications**:<br />- Grouped by nerve damage and functional impact:<br />  - **I**: Shoulder and elbow functions, typically 80% spontaneous recovery.<br />  - **II**: Wrist drop, about 60% recovery.<br />  - **III**: Complete flaccid paralysis without Horner syndrome, 30-50% recovery.<br />  - **IV**: Complete flaccid paralysis with Horner syndrome, requires surgery.<br /><br />**Management Timeline**:<br />- Evaluation and intervention protocols span from 1 month to 24 months, with specific milestones for assessments, interventions like Botox, and surgical considerations based on performance metrics and physical exams.<br /><br />**Shoulder Subluxation**:<br />- Common issue due to muscle imbalance, leading to glenohumeral dysplasia.<br />- Diagnosed using clinical exams and imaging tools like MRI and ultrasound, with the latter being a preferable real-time, non-anesthesia method.<br /><br />**Treatment Options**:<br />- **Botulinum Toxin**: Used to maintain muscle balance and prevent complications.<br />- **Nerve Surgery**: Including nerve transfers and reconstructions, targeted at functional recovery.<br />- **Tendon Transfer**: Improves certain arm movements but may decrease others.<br /><br />**Long-Term Management**:<br />- Emphasis on rehabilitation provider mindset: preventing contractures, managing ergonomics, pain, adaptive equipment, and recreation.<br /><br />The document provides a comprehensive understanding of BPP management, emphasizing early detection, tailored interventions, and continuous evaluation for optimal outcomes.

Keywords

brachial plexus palsy

BPP

infants

risk factors

injury types

diagnostic procedures

treatment protocols

shoulder subluxation

nerve surgery

long-term management