Erb's Palsy Causation: A Historical Perspective

Abstract

A better understanding of the forces involved when brachial plexus injury occurs has evolved over the past 10 to 15 years. A particular challenge was that all of the useful information had to be derived indirectly by identifying associations-a challenge that was met by individual researchers who made significant observations that, in turn, stimulated others to search for additional findings. Gradually the pieces of the puzzle began to form the picture. The significant steps in this journey were first, the recognition of the substantial number of injuries occurring without concurrent shoulder dystocia; second, the finding that a much greater frequency of injury is associated with an ultrashort second stage of labor; third, the observations that the injury rate is independent of the experience of the birth attendant; fourth, the recognition of the substantial numbers of injuries occurring in the posterior arm; and fifth, the anecdotal experience of countless delivery attendants, who relate that the forces applied in the injured cases were perceived to be no stronger than those applied when no injury occurred. We present a historical review for each step in this journey. We reviewed all articles published on this subject in Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology and some European journals. The period for review primarily covered articles published since 1980. Several textbooks on obstetrics and child neurology were also reviewed.

Risk factors for neonatal brachial plexus paralysis

“…Previously, it was assumed that brachial plexus paralysis occurs exclusively with and was a direct result of shoulder dystocia [7]. Others, however, have found that this is not always the case [8].…”

“…The labor-related factors are shoulder dystocia, prolonged second stage of labor, vaginal breech delivery, operative vaginal delivery and epidural analgesia. The most important fetal factor is macrosomia [2,4,[6][7][8]. Despite our knowledge of these risk factors, most patients have none of them and our ability to predict or prevent brachial plexus paralysis is extremely limited [4,6,9].…”

Algorithm for treatment of children of first months of life with brachial plexus birth palsy

“…Тракционно-ротационные акушерские ма-нипуляции (ручные, щипцы, вакуум-экстракция) [9][10][11][12][13][14].…”

Avaliação prognóstica de pacientes com plexopatia braquial obstétrica: comparação entre a avaliação clínica e o estudo da condução motora

“…No entanto, algumas evidências levaram essa teoria a ser contestada: cerca de metade dos pacientes com PBO não tem antecedente de distócia de ombro(DONNELLY et al, 2002;JENNET et al, 1992); cerca de um terço dos casos apresenta comprometimento do plexo em situação posterior, ou seja, oposto à sínfise púbica (WALLE;HARTIKAINEN-SORRI, 1993). A possibilidade de comprometimento do plexo braquial mesmo em cesáreas não traumáticas também lança dúvidas quanto ao mecanismo de lesão(GHERMAN et al, 1997).A constatação de que a PBO está associada a anormalidades do segundo estágio do trabalho de parto levou alguns obstetras a postularem que forças propulsivas maternas poderiam causar o estiramento do plexo(GHERMAN et al, 1998;HANKINS;CLARK, 1995;OUZOUNIAN et al, 1997;DEMOTT, 2002). A PBO está relacionada tanto a um segundo estágio prolongado(ANDERSAN et al, 2006), como "ultra-curto" (SANDMIRE;DEMOTT, 2002).…”

“…A possibilidade de comprometimento do plexo braquial mesmo em cesáreas não traumáticas também lança dúvidas quanto ao mecanismo de lesão(GHERMAN et al, 1997).A constatação de que a PBO está associada a anormalidades do segundo estágio do trabalho de parto levou alguns obstetras a postularem que forças propulsivas maternas poderiam causar o estiramento do plexo(GHERMAN et al, 1998;HANKINS;CLARK, 1995;OUZOUNIAN et al, 1997;DEMOTT, 2002). A PBO está relacionada tanto a um segundo estágio prolongado(ANDERSAN et al, 2006), como "ultra-curto" (SANDMIRE;DEMOTT, 2002). Haveria também rotação deficiente do feto, levando ao alinhamento do eixo dos ombros com o diâmetro ântero-posterior da pelve(GHERMAN et al, 1998).Jennet et al (1992) defendem a teoria da mal-adaptação intra-uterina como causa importante da PBO.…”