Neonatal brachial plexus palsy

From greek.doctor
  • 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