Transcript Brachial Plexus Inuries

Typical Spinal Nerve
Assisted Labor
Difficult Labor
Breech Presentation
Parturition
During the process of delivery a
slight force is applied at the
head to drag the baby out of the
birth canal.
If the force is severe it may
damage the brachial plexus
More common on right side and
usually upper roots C5 and C6
and sometime C7 roots injured
Sing
Symptoms
Begin with a letter “Y”, an “I” and a “Y”.
Add a “strike” and a “spare” (bowling scorekeeping symbols)
Draw “arches”.
Draw horizontal lines to separate the parts.
Roots
Trunks
Divisions
Cords
Branches
Begin labeling.
C5
C6
C7
C8
T1
Roots
Trunks
Upper
Middle
Lower
Medial
Posterior
Cords
Lateral
Divisions
Branches
SLOW
Musculocutaneous
Axillary
Median
Radial
Ulnar
Add details . . .
Branches off the posterior cord spell “ULTRA”
C5
C6
C7
C8
T1
Roots
Trunks
Upper
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Posterior
Cords
Lateral
Divisions
Branches
Musculocutaneous
SLOW
SLOW
Axillary
Median
Radial
Ulnar
“3M” comes off the medial cord.
C5
C6
C7
C8
T1
Roots
Trunks
Middle
Upper
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Posterior
Cords
Lateral
Divisions
Branches
Musculocutaneous
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
SLOW
SLOW
Axillary
Median
Radial
Ulnar
The lateral pectoral n. comes off the lateral cord.
C5
C6
C7
C8
T1
Roots
Trunks
Upper
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Lateral pectoral n.
Posterior
Cords
Lateral
Divisions
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
Branches
Musculocutaneous
Axillary
Median
Radial
Ulnar
There are 4 supraclavicular branches.
C5
C6
C7
C8
T1
Roots
Long
Thoracic n.
Dorsal Scapular n.
Trunks
Upper
N. to subclavius
Suprascapular n.
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Lateral pectoral n.
Posterior
Cords
Lateral
Divisions
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
Branches
SLOW
Musculocutaneous
Axillary
Median
Radial
Ulnar
That’s it!
The Brachial Plexus
C5
C6
C7
C8
T1
Roots
Long
Thoracic n.
Dorsal Scapular n.
Trunks
Upper
N. to subclavius
Suprascapular n.
Middle
Lower
Upper subscapular
Lower subscapular
Thoracodorsal
Medial
Lateral pectoral n.
Posterior
Cords
Lateral
Divisions
Medial pectoral n.
Medial cutan. n. of arm
Medial cutan. n. forearm
Branches
Musculocutaneous
Axillary
Median
Radial
Ulnar
Different Parts of Brachial Plexus in Relation to Clavicle
Supra-Clavicular Part
–Roots, Trunks
Retro-Clavicular Part
–Divisions
Infra-Clavicular Part
–Cords, Branches
Relation of Cords of Brachial Plexus with Axillary Artery
• Axillary Artery divided into
three parts 1st, 2nd and 3rd part
by means of Pectoralis minor
muscle.
• The cords of brachial plexus
surround the axillary artery.
• On the 2nd part of axillary
artery the cords of brachial
are lying lateral, medial and
posterior, that’s why they are
named
Causes of Brachial Plexus Injuries
A birth brachial plexus injury is
thought to be caused by an injury
involving the child's brachial
plexus during the delivery
process. This injury results in
incomplete sensory and / or motor
function of the involved arm.
Traumatic brachial plexus injuries
may occur due to motor vehicle
accidents, bike accidents, ATV
accidents, sports, etc. Nerve
injuries vary in severity from a
mild stretch to the nerve root
tearing away from the spinal cord.
Causes of Brachial Plexus Injuries
The nerves of the brachial plexus
can be injured during a difficult
delivery from:
The infant's head and neck pulling
toward the side as the shoulders
pass through the birth canal
Pulling on the infant's shoulders
during a head-first delivery
Pressure on the baby's raised arms
during a breech (feet-first) delivery
Types of Brachial Plexus Injuries
Erb's Palsy
Klumpke's Palsy
Complete Palsy
Types of Brachial Plexus Injuries
Erb's Palsy
C5, C6 and sometimes C7 nerves are
involved
Often presents with arm straight and
wrist fully bent (waiter's tip)
May have good hand function but not
full movement of the arm
May have instability of the shoulder
joint
Often presents with weak biceps and
deltoid muscles (unable to bend
elbow or lift arm at the shoulder)
Includes about 75 percent of all
brachial plexus injuries
Complete Damaged to Brachial Plexus
When all five nerves in the brachial
plexus are injured it is called
Complete Brachial Plexus palsy. The
child loses the ability to face forward
for any length of time (called
torticollis) and is sometimes also
afflicted with an eyelid droop on the
same side of the affected hand/arm
and constriction of the pupil (Horner’s
Syndrome). When paralysis occurs
in both the arm and hand, it is called
Klumpke’s palsy.
Klumpke's Palsy
(1% of cases) - involves C8T1; newborn will be unable to
grasp or flex wrist. If sympathetic
fibers of T1 are involved, there
may be an ipsilateral ptosis and
miosis (Horner's syndrome). This
pattern of injury is much less
common than Erb's. Prognosis is
also poorer than Erb’s.
Symptoms
Symptoms can be seen
immediately or soon after birth,
and may include:
Newborn is not moving the upper
or lower arm or hand
Absent Moro reflex on the
affected side
Arm flexed (bent) at elbow and
held against body
Decreased grip on the affected
side
Moro Reflex
The Moro reflex is a normal
reflex for an infant when he or
she is startled or feels like they
are falling. The infant will have
a "startled" look and the arms
will fling out sideways with the
palms up and the thumbs
flexed. Absence of the Moro
reflex in newborn infants is
abnormal and may indicate an
injury or disease.
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