Obstetrical Lesions of the Brachial Plexus

Rossi, Livia N.; Vassella, F; Mumenthaler, Marco

doi:10.1159/000115447

Cited by 34 publications

(4 citation statements)

References 4 publications

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“…They postulated that orthograde trans-synaptic degeneration of the postganglionic neuron had taken place. Although the association of Klumpke’s paralysis is well recognised,16this was not present in any of our patients.…”

Section: Discussioncontrasting

confidence: 51%

Does Horner's syndrome in infancy require investigation?

George

Gonzalez²,

Hoyt³

1998

British Journal of Ophthalmology

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Aims-To evaluate whether isolated Horner's syndrome presenting in the first year of life warrants investigation. Method-Retrospective review of 23 children presenting with Horner's syndrome in the first year of life. Results-In 16 patients (70%) no cause was identified. Birth trauma was the most common identifiable cause (four patients). Twenty one children (91%) had urinary vanillylmandelic acid (VMA) measured and 13 patients (57%) underwent either computed tomography or magnetic resonance imaging of the chest and neck. These investigations revealed previously undisclosed pathology in only two-one ganglioneuroma of the left pulmonary apex and one cervical neuroblastoma. A further patient was known to have abdominal neuroblastoma before presenting with Horner's syndrome. There were no cases of Horner's syndrome occurring after cardiothoracic surgery. Long term follow up of the patients (mean 9.3 years) has not revealed further pathology. Conclusions-Routine diagnostic imaging of isolated Horner's syndrome in infancy is unnecessary. Infants should be examined for cervical or abdominal masses and involvement of other cranial nerves. If the Horner's syndrome is truly isolated then urinary VMA levels and follow up in conjunction with a paediatrician should detect any cases associated with neuroblastoma. Further investigation is warranted if the Horner's syndrome is acquired or associated with other signs such as increasing heterochromia, a cervical mass, or cranial nerve palsies. (Br J Ophthalmol 1998;82:51-54) Horner's syndrome occurs as a result of a lesion anywhere along the oculosympathetic pathway from the hypothalamus to the orbit.

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Section: Discussioncontrasting

confidence: 51%

Does Horner's syndrome in infancy require investigation?

George

Gonzalez²,

Hoyt³

1998

British Journal of Ophthalmology

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“…The high frequency of difficult deliveries with associated injuries in this series, similar to the experience of other workers, suggests that traction and compression of the nerves were responsible for the lesions in our cases, rather than local injury to the shoulder and humerus. 4,8,[12][13][14] The late presentation to the hospital in the majority of our cases probably reflects the relatively good prognosis of the disease, as complete recovery is encountered in 70% to 92% of cases. 10,11,15 The proportion of the cases who reported late to the hospital most likely represents the group with more severe lesions, and as such, they have a poorer prognosis…”

Section: Discussionmentioning

confidence: 99%

Congenital Brachial Pals in the Eastern Province of Saudi Arabia

et al. 1990

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The clinical features of 57 patients (31 males, 26 females) with congenital brachial palsy seen at the King Fahd Hospital of the University over a 5-year period are described. Delivery was difficult in 32 (56%), 20 (35%) were large babies (birth weight greater than 3,600 g), and 20 deliveries required either forceps or vacuum extraction. The presentation at delivery was vertex in 45, breech in five, and shoulder in four. Associated injuries or features, encountered in 14 cases, were fractures of the clavicle and humerus (six cases each), and skull fracture and Horner's syndrome in one patient each. The right and left sides were involved in 31 and 24 cases, respectively, and both sides in only two cases. All the muscle groups of the affected limb were most commonly involved (40%), and hand muscles alone were affected in only one patient. Although 60% of the cases presented late to the hospital, functional recovery was observed in 63%. The major predisposing factors identified in this study were technically difficult deliveries, large infants, and breech or shoulder presentation with assisted delivery. It is suggested that early identification of these factors and improvement in obstetric care of both the mothers and babies during delivery would reduce the incidence and severity of this disability.

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“…While the definition of recovery has not been made clear, it has been stated that 80-90% complete neural recovery has been seen, according to studies. Meanwhile, other studies have found complete recovery in less that (approximately) 50% of cases [8][9][10][11]. Nervous recovery is not always accompanied by functional recovery, and sequelae, such as joint contractures and subluxations, may remain in some patients [12].…”

Section: Introductionmentioning

confidence: 99%

Examination of Upper Extremity Length Discrepancy in Patients with Obstetric Brachial Plexus Paralysis

et al. 2023

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Since the natural course of obstetric brachial plexus palsy is variable, several problems are encountered. One important question, in considering patients with OBPP under observation in outpatient clinical settings, is whether children will have length discrepancies in their arms. The aim of this study was to determine differences in the length of the affected extremity, in comparison to the opposite upper extremity. As such, 45 patients, aged 6 months to 18 years, with unilateral brachial plexus palsy developed due to obstetric reasons, were included in the study. Affected and healthy side humerus, ulna, radius, 2nd metacarpal and 5th metacarpal lengths were evaluated according to gender, age, side, Narakas classification, primary and secondary surgery. Statistically significant differences were found in the change rates of affected/healthy humerus, radius, 2nd metacarpal and 5th metacarpal lengths according to age (93%, 95%, 92%, 90% and 90%, respectively). Affected/healthy change rates of ulna, radius, 2nd metacarpal and 5th metacarpal lengths were found to differ statistically (p < 0.05) according to the Narakas classification variable (94%, 92%, 95%, 94% and 94%, respectively). There were no statistically significant differences in the ratios of affected/healthy change in the lengths of the humerus, ulna, radius and 5th metacarpal compared to the primary surgery (p > 0.05). The ratios of affected/healthy change in ulna, radius and 5th metacarpal lengths were found to differ statistically (p < 0.05) according to secondary surgeries (93%, 91%, 91% and 92%, respectively). Joint and bone deformities and bone shortening were observed after changes that occurred in the postnatal and growing periods due to obstetric brachial plexus palsy. Every increase in function to be gained in the upper extremity musculature was also potentially able to reduce problems, such as shortness.

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Obstetrical Lesions of the Brachial Plexus

Cited by 34 publications

References 4 publications

Does Horner's syndrome in infancy require investigation?

Does Horner's syndrome in infancy require investigation?

Congenital Brachial Pals in the Eastern Province of Saudi Arabia

Examination of Upper Extremity Length Discrepancy in Patients with Obstetric Brachial Plexus Paralysis

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