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Currents: Fall 2001, Volume 2, Number 4 Brachial Plexus Birth Palsy Management Zlatko Anguelov (in collaboration with R. Kumar Kadiyala, M.D., Ph.D.) History: Brachial plexus birth palsy presents as paralyses of the infant's arm resulting from obstetric injuries to the brachial plexus. Risk factors for birth injury include large size for gestational age, multiparous pregnancy, prolonged labor, or difficult delivery. Shoulder dystocia and difficult arm or head extraction increase the risk of brachial plexus stretching that usually causes neural injury. EMG studies have indicated an in utero cause in some cases. Figure 1. Brachial plexus (schematized) The location and range of neural lesions determine the type of arm muscles' dysfunction. In the majority of cases, the upper trunk (C5 and C6) is injured causing the so-called Erb's palsy. Less often, the entire plexus (C5 to T1) can be involved, while in a rare condition known as Klumpke's palsy only the lower trunk (C8 and T1) bears the lesions. Upper trunk injuries are generally postganglionic and have a better prognosis with regard to full recovery than the preganglionic lesions typical for the lower trunk. New facts: This palsy occurs in 0.1% to 0.4% of live births. Most infants who show signs of recovery during the first two months of life will subsequently have normal function. Those who do not recover in the first three months of life are at risk for long-term disability due to limited muscle strength and range of motion. Thus, the decision to allow for spontaneous reinnervation and muscle/motion recovery or to undertake microsurgical reconstruction of the injured plexus depends on the type of nerve lesion (stretch, rupture, or avulsion); the level of injury (partial or total); and the severity of the injury. | |
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