Brachial Plexus Injuries (BPI)
What are BPI? - correct answer ✔-Brachial Plexus = network of nerves
originating at C5-T1 supporting motor and sensory function of the arm
BPI History - correct answer ✔-Smellie 1768 was first to document as BPI
-Duchenne 1872 coined term Obstetrical Brachial Plexus
-Erb 1874 discussed upper plexus involvement: a localized lesion involving
C5-C6
Erb's Palsy (subcategory of BPI) - correct answer ✔-C5-C6 (sometimes C7)
involvement
-Shoulder and upper arm muscles are most affected
-Wrist extensors are also affected
-Arm positioned with shoulder internally rotated, elbow extended, and wrist
flexed
-Able to flex fingers for a grasp
-Most common type of BPI (~75%)
Total, Global, Complete Palsy (subcategory of BPI) - correct answer ✔-
Flaccid upper extremity (insensate, areflexic = no sensation or reflexes)
because all nerves are impacted
-Claw hand (at times)
Incidence of BPI - correct answer ✔1.5 per 1,000 live births
Mechanism of injury - correct answer ✔stretch/traction
, Presentation at birth - correct answer ✔Vertex, breech, or even C-section
Risk Factors of BPI - correct answer ✔-Increased birth weight (>4.5 kg) or
maternal diabetes
-Shoulder dystocia
-Breech presentation
-Instrumented delivery
-Prolonged labor
-54% with no know risk factors
Pediatric Brachial Plexopathy - correct answer ✔Perinatal = most common
(during birthing process)
Trauma = cycling/motor vehicle accident/ATV accident, sports, backpacks,
gun shot wound
Shoulder dystocia - correct answer ✔Occurs when, after delivery of the fetal
head, the baby's anterior shoulder gets stuck behind the mother's pubic bone
-Nerves damaged due to overstretch
Sensory Dermatomes - correct answer ✔-Sensory nerve fibers are included
in the brachial plexus network of nerves
-Correspond with the root level where the sensory nerve fibers originate
-So you can see what areas of the arm are associated with each nerve root
Nerve Injuries - correct answer ✔-Each of the 5 nerve of the brachial plexus
can be damaged in 4 ways
What are BPI? - correct answer ✔-Brachial Plexus = network of nerves
originating at C5-T1 supporting motor and sensory function of the arm
BPI History - correct answer ✔-Smellie 1768 was first to document as BPI
-Duchenne 1872 coined term Obstetrical Brachial Plexus
-Erb 1874 discussed upper plexus involvement: a localized lesion involving
C5-C6
Erb's Palsy (subcategory of BPI) - correct answer ✔-C5-C6 (sometimes C7)
involvement
-Shoulder and upper arm muscles are most affected
-Wrist extensors are also affected
-Arm positioned with shoulder internally rotated, elbow extended, and wrist
flexed
-Able to flex fingers for a grasp
-Most common type of BPI (~75%)
Total, Global, Complete Palsy (subcategory of BPI) - correct answer ✔-
Flaccid upper extremity (insensate, areflexic = no sensation or reflexes)
because all nerves are impacted
-Claw hand (at times)
Incidence of BPI - correct answer ✔1.5 per 1,000 live births
Mechanism of injury - correct answer ✔stretch/traction
, Presentation at birth - correct answer ✔Vertex, breech, or even C-section
Risk Factors of BPI - correct answer ✔-Increased birth weight (>4.5 kg) or
maternal diabetes
-Shoulder dystocia
-Breech presentation
-Instrumented delivery
-Prolonged labor
-54% with no know risk factors
Pediatric Brachial Plexopathy - correct answer ✔Perinatal = most common
(during birthing process)
Trauma = cycling/motor vehicle accident/ATV accident, sports, backpacks,
gun shot wound
Shoulder dystocia - correct answer ✔Occurs when, after delivery of the fetal
head, the baby's anterior shoulder gets stuck behind the mother's pubic bone
-Nerves damaged due to overstretch
Sensory Dermatomes - correct answer ✔-Sensory nerve fibers are included
in the brachial plexus network of nerves
-Correspond with the root level where the sensory nerve fibers originate
-So you can see what areas of the arm are associated with each nerve root
Nerve Injuries - correct answer ✔-Each of the 5 nerve of the brachial plexus
can be damaged in 4 ways
