Treatment protocol for neurological conditions
CONDITION: Brachial Plexus Injuries
The brachial Plexus is the large network of nerves to the upper limbs which extends from neck into the axilla. The supraclavicular part of the plexus is in the posterior triangle of the neck and its infraclavicular part is in the axilla.
The plexus is formed by the union of the ventral rami of nerves C5-C6 and the greater part of T1 ventral ramus. In addition of the rami the brachial plexus consist of trunk, divisions, cords and their branches.
Brachial Plexus injuries
Lesions are usually caused by variety of traumatic injuries.
Because they are a collection of peripheral nerves certain manifestations are produced when lesions occur, regardless of the origin of the injury.
Common injuries t of brachial plexus
· C5-C7 lead to winged scapula
· C5-6 ,T1(radial) lead to wrist drop, extensor paralysis
· C5-5, T1 (median) ape hand deformity, weakened grip, unopposed thumb.
· C8, T1 claw hand deformity, interosseus atrophy, loss of thumb add.
· Most upper brachial plexus injuries results from motorcycle accidents.
· When a person is thrown from a motorcycle, the shoulder usually hits something i.e. tree while the trunk and head cotttttntinue to move. This stretches or tears part of the plexus.
· Infants injury occurs during birth by violent stretching of the neck.
· Stab and bullet wounds usually affects the superior trunks of the brachial plexus.
· Injuries here results in characteristic position of the limb.
Lower brachial plexus injuries
They occur when the upper limb is suddenly pulled superiorly(infants’ shoulder is pulled forcefully during birth). The inferior trunk is affected.
The main problem reslting from injury are impaired wrist flexion and intrinsic muscle movements.
Medical treatment
A range of microsurgical techniques are applied in carefully selected cases.
External neurolysis- removal of constricting fibrous structures around the nerve.
Internal neurolysis- release of inta neural fibrosis
Nerve graft- this is done to prevent any tension in the repair. The sural nerve is available and ideal.
Neurotisation- when root tearing occurred available nerves may be grafted to the distal plexus for specific function.
OT treatment
Shoulder - mobilization (passives through full ROM)
Elbow - master sling fit according to inst.
Hand - Check for specific nerves i.e. radial, ulnar and medial
Supply appropriate splints
Hand with no function- Z splint
Patient position-elbow resting on the table
-wrist 30 degrees extension
- MCF 90 degrees
- IP’s full extension
- thumb abduction
Splint removed for mobilization
Please refer to peripheral nerve injury protocol for treatment of specific nerves.