Evaluation and Management of Obstetrical Brachial Palsy

Michael K. Rosner; Neal J. Naff

doi:10.1055/s-2001-12994

Seminars in Neurosurgery, Table of Contents

Seminars in Neurosurgery 2001; 12(1): 005-012
DOI: 10.1055/s-2001-12994

Evaluation and Management of Obstetrical Brachial Palsy

Michael K. Rosner¹ , Neal J. Naff²

¹Division of Neurosurgery, Walter Reed Army Medical Center, Washington, DC
²Mid-Atlantic Neurosurgical Associates, Baltimore, MD.

Abstract

ABSTRACT

Attitudes regarding surgical reconstruction of the brachial plexus have advanced with the evolution of microsurgical techniques not only in adults but also in infants with obstetrical plexus palsy. Recommendations regarding intervention range from the very conservative and nihilistic to the aggressive and unrealistic. Unfortunately, variations in the methodology and outcomes in reported clinical series have made results difficult to interpret. This article reviews the current attitudes regarding both the conservative and aggressive approaches to the management of obstetrical brachial plexus palsy and offers an algorithm for the appropriate management of these injured infants.

KEYWORD

Brachial plexus - obstetrical injury - nerve repair

Full Text

References

REFERENCES

1 Smellie W. A Collection of Cases and Observations in Midwifery. Edition 4, 1768. Volume 2, London
2 Shenaq S M. Brachial plexus birth injuries and current management. Clin Plast Surg . 1998; 25(4) 527-536
3 Meyer R D. Treatment of adult and obstetrical brachial plexus injuries. Orthopedics . 1986; 9(6) 899-903
4 Brown K L. Review of obstetrical palsies. Nonoperative treatment. Clin Plast Surg . 1984; 11(1) 181-187
5 Duchenne G BA. De L'electrisation Localisee et de Son Application a la Pathologie et a la Therapeutique. 1872. Edition 3. Paris: J.B. Balliere
6 Erb W. Ueber eine eigenthumliche localisation von lahmengen im plexus brachialis. Verhandl d Naturhist-Med . 1874; 2 130-136
7 Klumpke A. Contribution a l'etude des paralysies radiculaires du plexus brachial. Rev Med (Paris) . 1885; 5 591-595
8 al-Qattan M M, Clarke H M, Curtis C G. Klumpke's birth palsy. Does it really exist?. J Hand Surg [Br] . 1995; 20(1) 19-23
9 Clark L P, Taylor A S, Prout T P. A study on brachial brith palsy. Am J Med Sci . 1905; 130 670-679
10 Sever J W. Obstetric paralysis: Its etiology, pathology, clinical aspects and treatment. Am J Dis Chil . 1916; 12 541
11 Sharpe W. The operative treatment of brachial plexus paralysis. JAMA . 1916; 66 876-884
12 Gilbert A, Razaboni R, Amar-Khodja S. Indications and results of brachial plexus surgery in obstetrical palsy. Orthop Clin North Am . 1988; 19(1) 91-105
13 Piatt Jr H J. Neurosurgical management of birth injuries of the brachial plexus. Neurosurg Clin N Am . 1991; 2(1) 175-185
14 Piatt Jr H J, Hudson A R, Hoffman H J. Preliminary experiences with brachial plexus exploration in children: birth injury and vehicular trauma. Neurosurgery . 1988; 22(4) 715-723
15 Sever J. Obstetric paralysis: Report of eleven hundred cases. JAMA . 1925; 85 1862-1870
16 Fairbank H. Birth Palsy: Subluxation of the shoulder-joint in infants and young children. Lancet . 1913; 1 1217-1220
17 Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995; 11(4) 583-594 594-discussion 595
18 Eng G D. Obstetrical brachial plexus palsy (OBPP) outcome with conservative management. Muscle Nerve . 1996; 19(7) 884-891
19 Laurent J P. Neurosurgical correction of upper brachial plexus birth injuries. J Neurosurg . 1993; 79(2) 197-203
20 Levine M G. Birth trauma: incidence and predisposing factors. Obstet Gynecol . 1984; 63(6) 792-795
21 Hughes C A. Birth trauma in the head and neck. Arch Otolaryngol Head Neck Surg . 1999; 125(2) 193-199
22 al-Qattan M M, Clarke H M, Curtis C G. The prognostic value of concurrent clavicular fractures in newborns with obstetric brachial plexus palsy. J Hand Surg [Br] . 1994; 19(6) 729-730
23 al-Qattan M M. The first multi-disciplinary obstetrical brachial plexus clinic in Saudi Arabia. J Hand Surg [Br] . 1996; 21(1) 124-125
24 Al-Qattan M M. Accidental contact burns of the upper limb in children with obstetric brachial plexus injury [In Process Citation]. Burns . 1999; 25(7) 669-672
25 Gilbert A. Results of brachial plexus surgery and replacement operations in traumatic brachial plexus birth injury-induced paralysis. Orthopade . 1997; 26(8) 723-728
26 Gilbert A, Whitaker I. Obstetrical brachial plexus lesions. J Hand Surg [Br] . 1991; 16(5) 489-491
27 Mulloy E M, Ramos L E. Special rehabilitation considerations in the management of obstetrical brachial plexus injuries. Hand Clin . 1995; 11(4) 619-622
28 Kline D G, Hackett E R, Happel L H. Surgery for lesions of the brachial plexus. Arch Neurol . 1986; 43(2) 170-181
29 Terzis J K, Liberson W T, Levine R. Obstetric brachial plexus palsy. Hand Clin . 1986; 2(4) 773-786
30 Greenwald A G, Schute P C, Shiveley J L. Brachial plexus birth palsy: a 10-year report on the incidence and prognosis. J Pediatr Orthop . 1984; 4(6) 689-692
31 Gordon M. The immediate and long-term outcome of obstetric birth trauma. I. Brachial plexus paralysis. Am J Obstet Gynecol . 1973; 117(1) 51-56
32 Michelow B J. The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg. 1994; 93(1) 675-680 discussion 681
33 Gilbert J-LT. Obstetrical palsy: a clinical, pathologic, and surgical review. In: Microreconstruction of Nerve Injuries Philadelphia: WB Saunders 1987: 529-541
34 Brucker J. Brachial plexus birth injury. J Neurosci Nurs . 1991; 23(6) 374-380
35 Capek L, Clarke H M, Zucker R M. Endoscopic sural nerve harvest in the pediatric patient. Plast Reconstr Surg . 1996; 98(5) 884-888
36 Clarke H M. Obstetrical brachial plexus palsy: results following neurolysis of conducting neuromas-in-continuity. Plast Reconstr Surg. 1996; 97(5) 974-982 discussion 983-984