1. Obstetrical brachial plexus injuries

• Neonatal brachial plexus palsy, also called obstetrical brachial plexus injuries, refers to injuries to the brachial plexus acquired during delivery
• During birth the brachial plexus or its roots may be damaged
  • Especially if lateral traction (pulling) is applied to the foetus’ head (shoulder dystocia)
  • The condition is uncommon
• The result is paralysis
• Three types exist
  • Erb’s type – the upper arm is paralyzed
    • This is the most common
    • The superior trunk of the brachial plexus is affected
  • Klumpke’s type – the forearm is paralyzed
    • The inferior trunk of the brachial plexus is affected
  • Full brachial plexus palsy
    • The whole upper limb is paralyzed
    • The whole brachial plexus is affected
• Clinical features
  • Initially, regardless of type
    • The affected upper limb is internally rotated and flappy
  • Later
    • The affected part experiences paralysis, anaesthesia
  • In older children and adults the humerus is shorter
• Treatment
  • Many cases resolve spontaneously
  • Conservative
    • Shoulder is positioned in abducted position to prevent contractures
  • Surgery
    • Nerve graft
    • Muscle transfer