Week 4: Developmental Hip Dysplasia, Brachial Plexus, Erbs Palsy

what 2 tests for DDH

barlow and ortolani

barlow is to

sublux

ortolani is to

relocate

these test for

hip instability les than 12 months old

Because B&O can be negative after 3 months due to muscles, look for what 3 things

less than 60 hip abd, leg length discrepancy, asymmetrical thigh and gluteal folds

hip dislocation screen

older than 12 months, positioned supine with knees flexed and look for difference in height. shorter knee indicates posterior hip dislocation

why do ultrasounds with DDH

look for breech, family history, large baby, overdue, foot deformities, plagio/tort

outcomes with DDH

dysplastic changes and stress on joints if not corrected, may have issues with ortho or other participations as they age

brachial plexus injury is from

forceful traction and rotation to head when breetch can injury the nerves, clavicle, humerus, or sublux the shoulder

damage to c4 (not common) causes

ipsilateral hemiparesis of the diaphgram

when do you get brachial plexus injury

delivery, inter utero, traumatic later in life

3 patho associated with brachial plexus injury

neuropraxia, axontomesis, neurotmesis

prognosis of brachial plexus injury

axon regrowth expectations, full recovery up to 2 years

axon regrowth is how muhc

1mm a day or 1 inch a month

recovery can take (how long in lower vs upper arm)

4-6 months upper, 7-9 months lower

continued recovery can occur up to

2-4 yrs

risk factors of brachial plexus injury

shoulder sytocia, maternal diabetes, large gestational size, difficult delivery needing external assistance, prolonged labor, breech

impairments/concerns of brachial plexus injury

contracture, limb neglect, abnormal bone growth, sensory impairmnet is not equal to motor impairment

erbs palsy cn roots

c5-c6

klumpkes palsy cn roots

c8-t1

global palsy cn roots

c5-t1

erbs palsy leads to paralysis of

rhomboids, levator, serratus, RC, deltoid, brachialis, coracobrachialis, biceps, long extensors of wrist and fingers

preferred position if they have erbs palsy

shoulder IR/Ext/add, elbow ext, forearm pronated, wrist and finger flex

functional deficits with erbs

abduction, lateral rotation, flexion/supination

Klumpke palsy cause

traction or tear of lower trunk roots

kyumpke palsy cause

upward force on arm during delivery, trauma in adults

klumpke palsy mm deficits

intrinsic hand mm, lumbricals, hypothenar, thenar, interossei

klumpke palsy functional deficits

claw hand, lumbricals normally flex MCP and extend DIP/PIP

injury of thoracic outlet syndrome

compression of lower trunk and subclavian vessels

causes of thoracic outlet syndrome

cervical rib injury, pancoast tumor

TOS mm deficit

intrinsic hand mm

TOS functional deficits

atrophy of intrinsic hand mm, ischemia, pain and edema due to vascular compression

winged scapula injury

lesion of long thoracic n

cause of winged scapula

axillary node dissection after mastectomy, stab wounds

mm deficit of winged scapula

serratus

functional deficit in winged scapula

inability to anchor scapula to thoracic cage, cant abduct above horizontal plane

causes of thoracic outlet syndrome