PT 535: Brachial Plexus Injury

what is the etiology of peripheral brachial plexus injury?

brachial plexus nerves are stretched, compressed or torn during delivery

common risk factors:

- shoulder dystocia

- large birth weight

-maternal diabetes

- breech

- forceps or vacuum used

- prolonged labor

- previous infant with PBPI

what is the underlying pathophysiology of a PBPI?

neuropraxia = temporary conduction block, myelin damage only

axonotmesis = axon damaged, connective tissue intact, axonal regeneration required

neurotmesis = complete nerve rupture

nerve root avulsion = nerve pulled away from spinal cord

what are the different types of PBPIs?

erb's palsy (C5-C6) - most common!

extended erb's (C5-7)

total plexus injury (C5-T1)

klumpke palsy (C8-T1)

what are the 5 most common S&S?

arm weakness or paralysis

absent moro reflex

characteristic arm posture (shoulder adduction, IR, elbow extension, forearm pronation, wrist flexion)

reduced active ROM

muscle imbalance leading to contractures

what are prognostic factors?

return of biceps function by 3 months (GOOD)

neuropraxia injury least complicated

C5-6 best

what are the treatment options?

PT OT

HEP

stretching

strengthening

positioning

constraint-induced movement therapy

nerve grafting, nerve transfers, neurolysis

botox

serial casting

ortho surgery

when would bracing be indicated?

to maintain joint alignment, prevent contractures, optimize function, and support recovery