Obstetric brachial plexus injury

Abstract

Obstetric brachial plexus injury (OBPI), also known as birth brachial plexus injury (BBPI), is unfortunately a rather common injury in newborn children. Incidence varies between 0.15 and 3 per 1000 live births in various series and countries. Although spontaneous recovery is known, there is a large subset which does not recover and needs primary or secondary surgical intervention. An extensive review of peer-reviewed publications has been done in this study, including clinical papers, review articles and systematic review of the subject. In addition, the authors’ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Causes of OBPI, indications of primary nerve surgery and secondary reconstruction of shoulder, etc. are discussed in detail. Although all affected children do not require surgery in infancy, a substantial proportion of them, however, require it and are better off for it. Secondary surgery is needed for shoulder elbow and hand problems. Results of nerve surgery are very encouraging. Children with OBPI should be seen early by a hand surgeon dealing with brachial plexus injuries. Good results are possible with early and appropriate intervention even in severe cases.

Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

“…The author has discussed the BBPI strategies elsewhere in detail. [52] Children have a far greater regeneration capacity and distance to travel for the regenerating axons is far smaller. Thus potentially total reconstruction up to and including the hand intrinsic muscles is feasible even in an all 5 root injury if operated in time.…”

Intraoperative Mapping of Roots, Plexuses, and Nerves

“…A few reports exist, where individual nerves of the lumbosacral plexus were monitored and mapped, examples being the sciatic nerve MEP in hip arthroplasty (Sutter et al, 2012;Satcher et al, 2003) and SSEP in meralgia paresthetica (Seror, 2004). Obstetric brachial plexus injury is common (approximately 1 in 1,000 live births) and up to 20% to 30% kids may need surgical intervention (Pondaag et al, 2004;Thatte and Mehta, 2011) for recovery. Lesions include a neuroma in continuity, neurotmesis, or a root avulsion.…”

High resolution neurography of the brachial plexus by 3Tesla magnetic resonance imaging

“…27,28 Erb-Duchenne palsy or proximal paralysis of the brachial plexus results from lesion of nerve roots C5-C6, sometimes C7 too, or of the entire upper trunk. In 25% of the cases, the phrenic nerve is also compromised.…”