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A 3-month-old infant holds his limb in the position seen in Figure A. Examination reveals winged scapulae, and absent rhomboid, rotator cuff and latissimus dorsi function. Which is the most appropriate treatment plan?
Instruct the parents to perform passive shoulder abduction and external rotation, and elbow flexion exercises and reassess at 6 months of life.
Neuroma resection and sural nerve grafting
Neuroma resection and direct brachial plexus repair
Nerve transfer to biceps and brachialis branches of the musculocutaneous nerve using fascicles from median and ulnar nerves.
Latissimus dorsi transfer
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An infant first presents holding his limb in the position shown in Figure A. Birth history reveals that he was a large-for-gestational age infant and labor was prolonged. His orthopedist recommends passive stretching including shoulder abduction and external rotation. For which of the following scenarios is this an appropriate line of treatment?
One-month-old infant with partial antigravity biceps strength.
Four-month-old infant with scapula winging and elevated hemidiaphragm.
Seven-month-old infant with posterior glenoid dysplasia.
Eight-month-old infant with recent anterior Z-lengthening of the subscapularis tendon.
Five-month-old infant with recent ipsilateral latissimus dorsi and teres major transfer.
Which of the following is the most common long term consequence of untreated brachial plexus birth palsy?
A newborn child born via a difficult breech delivery is found to have a brachial plexus birth palsy. While initially born with a flail limb, the child regained elbow flexion at 10 weeks. At age 18 months (1.5 years old), which of the following deficits is most likely to be seen on physical exam?
Fixed adduction and internal rotation at shoulder with elbow extension
Hyperextension of the MCP joints and flexion of the IP joints of the hand
Weakness in elbow flexion
Normal physical exam without deficits
A 3-month-old is brought to clinic for evaluation of a right upper extremity abnormaility present since birth. Which of the following physical exam findings is associated with the best functional outcome?
Loss of hand function with preserved shoulder function
Absent shoulder abduction and external rotation with intact wrist and digit flexion and extension
Rotator cuff dysfunction, elevated hemidiaphragm, and absence of rhomboid function
Loss of shoulder and wrist function
Ptosis, myosis and anhydrosis
An infant is born with total brachial plexus palsy and Horner’s syndrome after a difficult vaginal delivery. What is the prognosis for spontaneous recovery of motor function in the involved arm by 3 months?
Which of the following muscles would be affected if a 6-month-old child sustains a birth-related brachial plexopathy affecting C5 nerve root?
Flexor digitorum profundus
An 18-month-old boy with obstetric brachial plexus palsy is being evaluated for limited right shoulder motion. Physical therapy for the past 6 months has failed to result in improvement of the contracture. Which of the following studies is necessary prior to any shoulder reconstruction?
MRI of the shoulder joint
MRI of the brain
Radiograph of the elbow
Aspiration of the right shoulder
In obstetrical brachial plexus palsy, which of the following signs is associated with the poorest prognosis for recovery in a 2-month-old infant?
Persistent inability to bring the hand to the mouth with the elbow stabilized at the side
Persistent inability to actively abduct the arm past 90 degrees
Persistent inability to externally rotate the shoulder past 20 degrees
Persistent unilateral ptosis, myosis, and anhydrosis
History of clavicle fracture at birth