Open access research obstetrical brachial plexus injury. Duchenne described in great detail four patients with an obstetric brachial plexus palsy, recognizing that their shoulder joint deformity was the result of a paralysis of the shoulder muscles. Obstetric brachial plexus injury pubmed central pmc. This is an overview of obstetric brachial plexus palsy obpp and erbs palsy. Brachial plexus palsy a therapy guide for your baby 2 of 8 brachial plexus palsy is caused by trauma to the nerves of the arm. Some examples of the main claimant and defence arguments are summarised. Intermediate type of obstetric brachial plexus palsy.
Obstetrical brachial plexus palsy pediatric neurology. These injuries arise most commonly, but not exclusively, from shoulder dystocia during a difficult birth. An evidencebased overview of examination and intervention principles is provided. Nath is a former assistant professor of the department of surgery and division of plastic surgery and department of neurosurgery. However, as logical as this may appear, one of the problems of evaluation of treatment is that methodologically sound studies of the natural history of obpp are scarce. Of these, with an upper palsy and 20 with a total palsy. Downloaded from subclassified into two groups according to early.
Your child will most likely improve as they get older. Obstetric brachial plexus palsy a guide to management contents introduction 4 types of injury, severity, and associated problems and injuries 5 muscles and segmental information 6 upper limb dermatomes 8 referral pathway 9 assessment of active movement 10 initial physiotherapy advice early management guidelines for parents 15. Obstetric brachial plexus palsy refers to a medical condition in which there is paralysis of the arm as a result of injury to the nerves originating behind the neck and going down the arm. The classic presenting features of obstetric brachial plexus palsy include atrophied muscles of the hands, symptoms of horner syndrome to include ptosis of the eyes and face. Most hospitals report one to two babies being born with a brachial plexus injury per births. Functional restrictions and growth impairment occurring as the child grows are treated either conservatively or operatively. Obstetric brachial plexus palsy wiley online library.
Obstetric brachial plexus palsy affects about 1 in every 200 births. Severe nerve injuries are generally treated by early microsurgical nerve repair. Articles journal of brachial plexus and peripheral nerve. Reaffirmed 2019 the american college of obstetricians and gynecologists convened the task force on neonatal brachial plexus palsy to develop a comprehensive report summarizing the scientific literature on. This has led to several published papers on the topic dealing with the reclassification of the types of palsy, its risk factors, aetiology, evaluation, prognosis and new concepts. As long as the outer sheath or covering of the nerve is. The brachial plexus is a network of peripheral nerves providing innervation to the upper extremity. The purpose of the study was to analyze shoulder, elbow and forearm function in children with persistent obstetric brachial plexus palsy. The brachial plexus is often damaged when it is under tension.
Pdf narakas classification of obstetric brachial plexus. Obstetric brachial plexus palsy obbp occurs at the time of childbirth, when none of these are complete. The overall incidence of nbpp, both transient and persistent impairment, is 1. Each nerve supplies movement and feeling to specific areas in the arm and hand. An example of conflicting findings relates to the duration of the second stage of labor. Obstetric brachial plexus palsy is a rare but sometimes very serious complication of defined highrisk deliveries. Most articles equate neonatal brachial plexus palsy with obstetrical brachial plexus palsy, demonstrating a lack of precision in the literature. Obstetric brachial plexus palsy affects about 1 in every. It is more common in larger babies, but can occur in babies of any weight. Pdf obstetric brachial plexus injury obpi, also known as birth brachial plexus injury bbpi, is unfortunately a rather common injury in. Obstetric brachial plexus injury obpi occurs in 1 to 3 births per in countries with welldeveloped obstetric services. Obstetric brachial plexus palsy brachial plexus treatment. This course introduces the pathophysiology and potential functional sequelae of obstetric brachial plexus palsy obpp. Some investigators found a precipitous second stage of.
These nerves originate in the fifth, sixth, seventh and eighth cervical c5c8, and first thoracic t1 spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and hand. Also affiliated with the texas medical center in houston and the texas medical school northwestern university medical school chicago il. The aim of the current study is to investigate the percentage of. Brachial plexus palsy is a potentially serious complication of child birth, with a reported incidence of 0. Erbs palsy is a paralysis of the arm caused by injury to the upper group of the arms main nerves, specifically the severing of the upper trunk c5c6 nerves. Method obstetric and neonatal data parity, diabetic status, pregnancy gestation, mode of cephalic delivery and birthweight were collected using a standardised proto col and correlated to neurological severity of the brachial plexus lesion. Brachial plexus injury bpi results in insult to the descending motor projections and sensory input. For the development of treatment strategies for infants with obstetric brachial plexus palsy obpp, knowledge of the expected degree of spontaneous recovery is fundamental. Acquire knowledge of the current methodologies involved in primary and secondary brachial plexus reconstruction. The brachial plexus is a network of nerve fusions and divisions that originate from cervical and upper thoracic nerve roots and terminate as named nerves that innervate muscles and skin of the shoulder and arm. Clinically, neonatal brachial plexus palsy nbpp presents in a newborn as a weak or paralyzed upper extremity, with the passive range of motion greater than the active.
These unusual cases were studied in detail with regard to clinical presentation and electrophysiological findings as well as management and spontaneous motor recovery. The reaction of muscles to direct application of electrical current was investigated thoroughly, making duchenne one of the first electromyographers. Functional restrictions and growth impairment occurring as the child. Brachial plexus injuries during the birthing process can leave infants with. Nath is a specialist in brachial plexus injury and erbs palsy treatment surgery. The natural history of obstetric brachial plexus injury. One feature of the mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The brains response to obbp is not well established. Erbduchenne palsy william smellie, a british obstetrician is credited with the first medical description of obstetric brachial plexus palsy. Oriinal article anatomical study of the brachial plexus in. Surgical management of obstetric brachial plexus palsy secondary. It first describes the anatomy of the brachial plexus. Date s, kurumadani h, yoshimura m, fukae a, onishi k, hayashi j, et al.
Natural history of obstetric brachial plexus palsy. A discussion is presented concerning scoring while assessing shoulder function. Obstetric brachial plexus palsy department of obstetrics. Pdf obstetric brachial plexus palsy risk factors and. We aimed also to evaluate relationship between age, severity of root involvement and functional deficit of. The published incidence of obstetric brachial plexus palsy varies considerably. Obstetrical brachial plexus palsy, one of the most complex peripheral nerve injuries, presents as an injury during the neonatal period.
Conventional treatment of obstetric brachial plexus injury advocates early diagnosis and followup accompanied by physiotherapy and. Although spontaneous recovery is known, there is a large. Although most injuries are transient, with full return of. This activity is directly related to the practice of physical therapy and is therefore appropriate for the pt and pta.
Mollberg m, hagberg h, bager b, lilja h, ladfors l obstet gynecol 2005. Divergence in observation and in interpretation of what is observed may give rise to serious disagreement about indications for s. In the late 1800s, the different types of nbpp were defined. The first clinical description of neonatal brachial plexus palsy nbpp was reported in the 1760s. Obstetric brachial plexus palsy is a potentially devastating form of cervical nerve. Gilbert, a, ramondi, p birch, r, bonney, g, wynn parry, c evaluation of results in obstetric brachial plexus palsy. Currently, the terms erbs palsy and erbsduchennes palsy indicates upper brachial plexus injury involving the c5, c6, and c7 roots. The term birthrelated brachial plexus palsy brbpp refers to injury noted in the perinatal period to all or a portion of the brachial plexus. Obstetrical brachial plexus palsy is defined as a flaccid paresis of an upper extremity due to traumatic stretching of the brachial plexus received at birth, with the passive range of motion greater than the active. Obstetric palsy injury to all or portion of a child brachial plexus occurring at that time of the delivery. Obstetrical brachial plexus palsy is a traction neural injury sustained during the course of the birth process. Obstetric brachial plexus palsy is a rare condition occurring in about 1 per thousand of live births.
Pdf upper limb function in children with obstetric. Shoulder dystocia is, therefore, closely associated with the most severe cases of permanent obstetric brachial plexus injuries 8, 9, 11. Patient information obstetric brachial plexus palsy erbs. The nerves of the brachial plexus have some ability to repair themselves. Measurement of external rotation of the shoulder in patients with obstetric brachial plexus palsy. The mallet grading system is a commonly used functional scoring system to assess shoulder abductionexternal rotation deficits in children with obstetric brachial plexus palsy. Obstetric brachial plexus injury obpi, also known as birth brachial plexus injury bbpi, is unfortunately a rather common injury in newborn children. Excessive lateral traction on the head so that the head is pulled away from the shoulder. Ii risk factors for obstetrical brachial plexus palsy among neonates delivered by vacuum extraction. A brachial plexus injury bpi, also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand.
During birth, after the delivery of the babys head, the babys shoulder may become stuck in the mothers pelvis. Severe brachial plexus palsy in women without shoulder. Understanding brachial plexus palsy the royal childrens hospital. Obstetric brachial plexus palsy definition of obstetric. Obstetrical brachial plexus injury obpi is an injury in newborns, thought to be sustained during labour and delivery. Good results are possible with early and appropriate intervention even in severe cases. These form part of the brachial plexus, comprising the ventral rami of spinal nerves c5c8 and thoracic nerve t1. Obstetrical brachial plexus palsy results from injury to the cervical roots c 5c 8 and thoracic root t 1. This may not be tolerated by some children because of sensitivity, but in others it will increase awareness of the affected arm. Then we will go over the different clinical presentation of. Abstract since the description by smellie in 1764, in a french midwifery text, that first suggested an obstetric origin for upper limb birth palsy, great strides have been made in both diagnosis and early and late treatment.
This trauma may have caused muscle weakness, lack of movement, andor lack of feeling in your babys arm. Short communication birth palsy obstetric brachial plexus. The incidence of obstetric brachial plexus palsy obpp ranges globally from 0. Extraforaminal lesions are as a rule postganglionic lesions and are referred to as nerve ruptures. Obstetric brachial plexus palsy obpp erbs palsy youtube. Obstetric brachial plexus palsy linkedin slideshare. Obstetric brachial plexus palsy a framework for therapy. Severe nerve injuries are generally treated by early microsurgical nerve repair 8, e1. Nath brachial plexus injury expert specializing in.