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Physiotherapy Following Brachial Plexus Birth Palsy(BPBP)
N.SARANYA. PT Dr. S.RAJA SABAPATHY, MS M Ch DNB FRCSDepartment
of hand therapyGANGA HOSPITALCOIMBATORE.
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Birth Palsy It is a low velocity injury
Partial injuries to the roots are common
When fully ruptured, the distance between the roots to be
bridged is not much and some regeneration is possible
Useful function of the affected muscles will return in most
cases
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Problem : Co - ContractionsAdductors with Abductors
Internal Rotators with External Rotators
Elbow Flexors with Abductors of shoulder
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The other problem: Recovery of one group of muscles earlier and
better then its antagonist muscle
Unopposed action of this group causes contractures
All this is super imposed on growth
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PrimaryEffectsSecondaryEffectsTertiaryEffects
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Classical Deformity
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Role of PhysiotherapistPre operative Immediate post
operativeLong term follow up
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Aim of PhysiotherapyTo Maintain Joint Range of MotionTo Prevent
DeformitiesTo obtain an optimal Functional Outcome After Surgical
Intervention Sensory re-educationSplintingParent / Patient
satisfactionEnhance ADL
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AssessmentPersonal historyPrevious history of
treatmentClinical1. Modified Mallet score2. Strength 3. Sensory4.
stereo gnosis5. Motor grading6. ROM
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Proforma
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Early Physiotherapy
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Horizontal
BoneVertical Muscle Surgical Options
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Postoperative Physiotherapy
Shoulder external and internal rotation exercises
Active assisted shoulder abduction
Stretching of shoulder abductors
Strengthening of shoulder abductors
Passive movements of distal joints
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Home program
Overhead pulley exercisesPicking up of objects and placing over
headFinger ladder exercisesWand exercises promoting shoulder
abductionTo encourage eating, bathing, buttoningSwimming the best
exercise.
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Statue of Liberty Splint
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Age - 2y 1mPreoperative Postoperative 1 y
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Age - 1 yr 4mPreoperative Postoperative 4 m
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Results Preoperative average abduction- 81degrees (Range:20-150
degrees)
Postoperative average abduction- 144degrees (Range: 80-180
degrees)
Increase in abduction range-63degrees (Range:20-110 degrees)
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Results
Mallet score improves by an average of 2.5 points
Overall symmetry of the movements at limb in improved
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What can not be expected Total correction of Internal Rotation
Deformity at the Shoulder
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SHEAR Deformity Scapula Hypoplasia Elevation And Rotation Nath
RK, Lyons AB, Melcher SE, Paizi M. Surgical correction of the
medial rotation contracture in obstetric brachial plexus palsy. J
Bone Joint Surg 2007, 89B: 1638-44.
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Triangular Tilt Operation
Osteotomy of the clavicle (middle third and distal third
junction )Osteotomy of the acromion at the site where it
narrows.Shaving of the protruding medial border of the scapula.
Anterior capsular release/ Posterior capsuloraphy
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Immobilization
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Post op Physiotherapy1st weekMaintain the splint all the time
remove only during exercises and gentle cleaningGravity eliminated
rotation of the shoulder jointElbow bending and straighteningHand
mobilization
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2nd weekMaintain the splint all the time remove only during
exercises and gentle cleaningContinue all exercise in 1st weekADD:
Gentle passive shoulder abduction to 120degree
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3rd week
Maintain the splint all the time remove only during exercises
and gentle cleaningAdduction of armGentle passive shoulder
abduction to 140degreeActive abduction as much as toleratedActive
and passive external rotation by keeping arm side of body and elbow
flexed to 90degreeElbow and hand mobilization
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4th week
Passive shoulder abduction to 180degreesActive shoulder
abduction as much as possible, increase range every day.Passive
external rotation of shoulder by keeping the arm by side of chest
and elbow fixed to its full rangeEncourage active external rotation
as much as possible.
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After 4 weeks
During day time remove the splint for few hoursStart with
2hrs/day during 5th week; 5hrs/day during 6th week, 8hrs/day in 7th
week and 12 hrs in 8th week.Continue all exercisesExercise can be
made more aggressive.
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After 8 weeksNo splint required during dayNight splint to be
continued for 6 months More aggressive physiotherapy.
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Triangular Tilt ResultsPre opPost op
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Triangular Tilt ResultsPre opPost op
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Pre-opPost-op
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Mallet scoreMallet score improves by an average of 2.5
points
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T H A N K Y O U F O R Y O U R T I M E & P A T I E N C E
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