Management of Brachial Plexus Birth Injury: The SickKids Experience

Abstract

This article describes the approach utilized by the multidisciplinary team at Sick Kids Hospital to evaluate and treat patients with brachial plexus birth injury (BPBI). This approach has been informed by more than 30 years of experience treating over 1,800 patients with BPBI and continues to evolve over time. The objective of this article is to provide readers with a practical overview of the Sick Kids approach to the management of infants with BPBI.

Keywords

brachial plexus - birth injury - microsurgery - glenohumeral dysplasia

Publication History

Article published online:
26 July 2023

• References

• 1 Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews DF. The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg 1994; 93 (04) 675-680 , discussion 681
• 2 Fisher DM, Borschel GH, Curtis CG, Clarke HM. Evaluation of elbow flexion as a predictor of outcome in obstetrical brachial plexus palsy. Plast Reconstr Surg 2007; 120 (06) 1585-1590
• 3 Borschel GH, Clarke HM. Obstetrical brachial plexus palsy. Plast Reconstr Surg 2009; 124 (1, Suppl): 144e-155e
• 4 Bade SA, Lin JC, Curtis CG, Clarke HM. Extending the indications for primary nerve surgery in obstetrical brachial plexus palsy. BioMed Res Int 2014; 2014: 627067
• 5 Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin 1995; 11 (04) 563-580 , discussion 580–581
• 6 Curtis C, Stephens D, Clarke HM, Andrews D. The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg Am 2002; 27 (03) 470-478
• 7 Verchere C, Durlacher K, Bellows D, Pike J, Bucevska M. An early shoulder repositioning program in birth-related brachial plexus injury: a pilot study of the Sup-ER protocol. Hand (N Y) 2014; 9 (02) 187-195
• 8 Al-Qattan MM, Clarke HM, Curtis CG. The prognostic value of concurrent Horner's syndrome in total obstetric brachial plexus injury. J Hand Surg [Br] 2000; 25 (02) 166-167
• 9 Lin JC, Schwentker-Colizza A, Curtis CG, Clarke HM. Final results of grafting versus neurolysis in obstetrical brachial plexus palsy. Plast Reconstr Surg 2009; 123 (03) 939-948
• 10 Davidge KM, Clarke HM, Borschel GH. Nerve transfers in birth related brachial plexus injuries: where do we stand?. Hand Clin 2016; 32 (02) 175-190
• 11 O'Grady KM, Power HA, Olson JL. et al. Comparing the efficacy of triple nerve transfers with nerve graft reconstruction in upper trunk obstetric brachial plexus injury. Plast Reconstr Surg 2017; 140 (04) 747-756
• 12 Daly MC, Bauer AS, Lynch H, Bae DS, Waters PM. Treatment and Outcomes of Brachial Plexus Birth Injury (TOBI) Study Group. Outcomes of late microsurgical nerve reconstruction for brachial plexus birth injury. J Hand Surg Am 2020; 45 (06) 555.e1-555.e9
• 13 Bains R, Kattan A, Curtis CG, Stephens D, Borschel G, Clarke HM. Active range of motion over time in patients with obstetrical brachial plexus palsy: a 10-year analysis. J Hand Surg Am 2018; 43 (04) 386.e1-386.e7
• 14 Vu AT, Sparkman DM, van Belle CJ, Yakuboff KP, Schwentker AR. Retropharyngeal contralateral C7 nerve transfer to the lower trunk for brachial plexus birth injury: technique and results. J Hand Surg Am 2018; 43 (05) 417-424
• 15 La Scala GC, Rice SB, Clarke HM. Complications of microsurgical reconstruction of obstetrical brachial plexus palsy. Plast Reconstr Surg 2003; 111 (04) 1383-1388 , discussion 1389–1390
• 16 Chow BC, Blaser S, Clarke HM. Predictive value of computed tomographic myelography in obstetrical brachial plexus palsy. Plast Reconstr Surg 2000; 106 (05) 971-977 , discussion 978–979
• 17 Gilbert A, Razaboni R, Amar-Khodja S. Indications and results of brachial plexus surgery in obstetrical palsy. Orthop Clin North Am 1988; 19 (01) 91-105
• 18 Vredeveld JW, Richards R, Rozeman CA, Blaauw G, Slooff AC. The electromyogram in obstetric brachial palsy is too optimistic: fiber size or another explanation?. Muscle Nerve 1999; 22 (03) 427-429
• 19 Davidge KM, Marcus JR, Clarke HM. Management of obstetrical brachial plexus palsy. In: Bentz ML, Bauer BS, Zuker RM. eds. Principles and Practice of Pediatric Plastic Surgery. 2nd ed. New York, NY: Thieme; 2016: 1613-1642
• 20 Swan MC, Clarke HM. Microsurgery for obstetrical brachial plexus palsy. In: Abzug JM, Kozin S, Zlotolow DA. eds. The Pediatric Upper Extremity. New York, NY: Springer; 2015: 607-631
• 21 Redett R, Hawins C, Murji A. et al. The value of intraoperative frozen section histology during obstetrical brachial plexus reconstruction. In: Proceedings of the Ninth International Federation of Societies for Surgery of the Hand; Budapest, Hungary; June 2004
• 22 Dupere M, Vajsar J, Moncada M. The use of intraoperative somatosensory evoked potentials in the diagnosis of nerve root avulsion in obstetrical brachial plexus palsy. In: Eighth Congress of the International Federation of Societies for Surgery of the Hand; Istanbul, Turkey; June 2001
• 23 Davidge KM, Ho ES, Curtis CG, Clarke HM. Surgical reconstruction of isolated upper trunk brachial plexus birth injuries in the presence of an avulsed C5 or C6 nerve root. J Bone Joint Surg Am 2021; 103 (14) 1268-1275
• 24 Tse R, Marcus JR, Curtis CG, Dupuis A, Clarke HM. Suprascapular nerve reconstruction in obstetrical brachial plexus palsy: spinal accessory nerve transfer versus C5 root grafting. Plast Reconstr Surg 2011; 127 (06) 2391-2396
• 25 Gilchrist DK. A stockinette-Velpeau for immobilization of the shoulder-girdle. J Bone Joint Surg Am 1967; 49 (04) 750-751
• 26 Soldado F, Fontecha CG, Marotta M. et al. The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model. J Shoulder Elbow Surg 2014; 23 (07) 1003-1009
• 27 van der Sluijs JA, van Ouwerkerk WJ, de Gast A, Wuisman PI, Nollet F, Manoliu RA. Deformities of the shoulder in infants younger than 12 months with an obstetric lesion of the brachial plexus. J Bone Joint Surg Br 2001; 83 (04) 551-555
• 28 Bauer AS, Lucas JF, Heyrani N, Anderson RL, Kalish LA, James MA. Ultrasound screening for posterior shoulder dislocation in infants with persistent brachial plexus birth palsy. J Bone Joint Surg Am 2017; 99 (09) 778-783
• 29 Pöyhiä TH, Lamminen AE, Peltonen JI, Kirjavainen MO, Willamo PJ, Nietosvaara Y. Brachial plexus birth injury: US screening for glenohumeral joint instability. Radiology 2010; 254 (01) 253-260
• 30 Arad E, Stephens D, Curtis CG, Clarke HM. Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy. Plast Reconstr Surg 2013; 131 (06) 1307-1315
• 31 Greenhill DA, Wissinger K, Trionfo A, Solarz M, Kozin SH, Zlotolow DA. External rotation predicts outcomes after closed glenohumeral joint reduction with botulinum toxin type a in brachial plexus birth palsy. J Pediatr Orthop 2018; 38 (01) 32-37
• 32 Zuo KJ, Es Ho, Hopyan S, Clarke HM, Davidge KM. Recent advances in the treatment of brachial plexus birth injury. Plast Reconstr Surg 2023; 151 (05) 857e-874e
• 33 Waters PM, Smith GR, Jaramillo D. Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am 1998; 80 (05) 668-677
• 34 Dodwell E, Hopyan S. Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy. JBJS Essential Surg Tech 2012; 2 (04) e23
• 35 Mallet J. Paralysie obstétricale du plexus brachial. II. Thérapeutique. Traitement des séquelles. Primauté du traitement de l'épaule. Méthode d'expression des résultats. Rev Chir Orthop Reparatrice Appar Mot 1972; 58 :Suppl 1: 166-168
• 36 Ho ES, Curtis CG, Clarke HM. The brachial plexus outcome measure: development, internal consistency, and construct validity. J Hand Ther 2012; 25 (04) 406-416 , quiz 417
• 37 Nikolaou S, Cramer AA, Hu L, Goh Q, Millay DP, Cornwall R. Proteasome inhibition preserves longitudinal growth of denervated muscle and prevents neonatal neuromuscular contractures. JCI Insight 2019; 4 (23) e128454
• 38 Ho ES, Roy T, Stephens D, Clarke HM. Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy. J Hand Surg Am 2010; 35 (01) 84-91
• 39 Ho ES, Parsons JA, Davidge K, Clarke HM, Lawson ML, Wright FV. Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture. PM R 2022; 14 (08) 971-986