Part 1. Injuries to the Brachial Plexus

Abstract

Upper-arm weakness (paresis) or paralysis indicates peripheral-nerve damage to the brachial plexus, a network of lower cervical and upper thoracic spinal nerves supplying the arm, forearm, and hand. Physical findings reflect muscle paralysis from spinal nerve roots. The mechanism of injury includes maternal, obstetric, and infant factors that apply traction on or compression to the anatomically vulnerable brachial plexus. Nerve regeneration can occur if nerve tissue components are preserved. Recovery is affected by multiple factors, including the type and site of injury, intervention timing, and developmental factors. The majority of injuries recover in days or months; however, residual deficits can persist. Part 1 of 2 of this article provides an overview of the neurophysiology of peripheral-nerve damage and nerve regeneration. The multifactorial etiology of brachial plexus injuries will be reviewed. Photographs and on-line video clips will enhance the description of the brachial plexus injury classifications and illustrate mechanisms of shoulder dystocia and obstetric relief maneuvers. A systematic approach to the physical examination will be explored in Part 2. Serial evaluation of motor function recovery is essential and is accomplished by appropriate referrals and follow-up. Part 2 will also describe treatment options and discuss anticipatory parent guidance.

The Impact of Pediatric Brachial Plexus Injury on Families

“…[4] More severe injuries often have long-term, varying degrees of restricted function through the shoulder, arm, and/or hand. [2, 5, 6]…”

Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus

“…Anesthetic blocks, surgical approaches, the interpretation of a nervous compression having unexplained clinical symptoms (sensory loss, pain, wakefulness and paresis), and these structures being compromised represent the clinical importance of these variations [8,9]. Dorsal scapular, long thoracic, suprascapular, subscapularis and thoracodorsal origins were studied to show variable BP collateral arrangements.…”

Historia natural de la lesión de plexo braquial de nacimiento

“…Las lesiones por axonotomesis pueden tener una recuperación funcional completa, una recuperación parcial o ningún tipo de recuperación, dependiendo de la extensión del daño axonal presentado y el número de raíces involucradas. 8,14,29,30 www.medigraphic.org.mx PRONÓSTICO El pronóstico dependerá de los factores de riesgo presentados, el tipo de lesión, la extensión del daño y la fecha de inicio del tratamiento médico y/o quirúrgico. Aun cuando hay estudios multicéntricos recientes que indican que no modifica el pronóstico realizar una cirugía temprana (edad promedio 4.2 meses) en comparación con la cirugía tardía (edad promedio 10.7 meses), 31 no se encontraron diferencias funcionales con seguimiento a uno o dos años en un grupo de 32 pacientes, los cuales fueron tratados con injertos nerviosos o transferencias nerviosas.…”