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All you need to know about obstetrical brachial plexus injury

WRITTEN AND PUBLISHED BY PTT. THOMAS ADJEI BIO ON
         
THE BRACHIAL PLEXUS INJURY
The term plexus simply means network of nerves or a group of nerves. The brachial plexus is nerve bundle that originate from the C5 spinal nerve root to T1 spinal nerve root.

The brachial plexus is nerve bundle that divides into different nerves supply the muscles of the upper limb, the muscles of the shoulder, arm, forearm and that of the hands.

Injury to the brachial plexus can result in impaired nerve conduction, resulting in weakness of the corresponding muscles supplied by these nerves. Sensational problems as well as severe pain along the dermatomes may be symptoms of brachial plexus injury.

Brachial plexus injury can be caused by fall resulting in an outstretched hand.

However, other factors can increase the risk of injuring of the brachial plexus.
These factors are :
Breech delivery 
Shoulder dystocia
Trauma: blow to the anterior of the shoulder 
Cephalopelvic disproportion that may result in puling of the baby during delivery 
Forcep delivery 
Macrosomia
and any other surgical intervention that may cause the brachial plexus to be injured. 

There are two aim forms of the brachial plexus injury.

 THE ERB'S PALSY (C5-C6 nerve root Affectation)

 THE KLUMPKE(C8-T1 nerve root  affectation)

The ERB'S Palsy is a from of brachial plexus injury that occurs as a result of injury to the C5 and C6 spinal nerve roots.
This injury may result in the affectation of muscles of the shoulder, arm and the forearm. The arm is usually seen as WAITER'S OR PORTER'S TIP
There is maximal adduction of the shoulder, extension of the elbow joint,wrist flexion, forearm pronation, shoulder internal rotation and flexion of the fingers.





KLUMPKE PALSY.

This is another form of brachial plexus injury with C8 and T1 nerve root affectation. Paralysis affect the intrinsic muscles of the affected hand and the long flexors of the wrist and fingers are also affected. But the thumb and the MCP joints of the fingers are extended.  It is mostly seen as the CLAW HAND.
The involvement of the T1 spinal nerve root may cause a HORNER'S SYNDROME(Ptosis,miosis and anhydrosis)
Ptosis is the constriction of the eyelid of the eye.
Miosis is the constriction of the pupil

Anhydriasis is the lack of tears flow of the affected eye(dryness of the orbit).




Both klumpke and erb's palsy can be treated with the intervention of a physical therapist or physical therapy technician.
Physiotherapy management target techniques that would :
Reduce pain
Correct the deformity
Improve muscle strength
Restore limb function.

PHYSIOTHERAPY MANAGEMENT
Depending on the presentation of the patient and impairment, physiotherapy may be more particular about positioning.
POSITIONING of the involved limb, if in the case of erb's palsy, would be reverse of position of the limb the condition has caused. Whilst this is the same as in klumpke situations.

IN THE CASE OF ERB'S PALSY 
Shoulder adduction-shoulder abduction
Shoulder internal rotation -shoulder external rotation
Wrist flexion-wrist extension
Forearm pronation -supination
Elbow extension -mid ROM flexion
Finger flexion -extension

This can be maintained with orthotic devices the may be prescribed by the physical therapist.

The physical therapist would design activities that would enhance use of the affected limb to restore function and to assist in developing muscular strength in the limb.

Strengthening exercises are beneficial

Stretching exercises would be helpful too
Tactile stimulation can be helpful in improving sensation

Passive mobilization is also a relevant part of treatment in dealing with reduced ROM of joints.
Active and passive exercises may be helpful in reducing Atrophy and maintenance of  muscle tone.
THANKS FOR READING THIS ARTICLE
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ARTICLE BY :THOMAS ADJEI BIO of PHYSIOTHERAPY AND ORTHOTICS TRAINING SCHOOL, DUAYAW NKWANTA.

Comments

THOMAS ADJEI BIO(PTT. ADJEI) said…
Thanks for the article, what causes the waiter's tip in erb's palsy?
October 19, 2019 at 9:32 AM
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