PDF herunterladen
CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2025; 20(01): e27-e30
DOI: 10.1055/a-2572-2601
Short Communication

Intraoperative Assessment of Nerve Traction Injury in Obstetric Brachial Plexus Palsy

J. Bahm
1   Division of Plexus Surgery, Department for Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH, Aachen, NRW, Germany
,
B. Schäfer
1   Division of Plexus Surgery, Department for Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH, Aachen, NRW, Germany
,
K. Nolte
2   Institute of Neuropathology, University Hospital RWTH, Aachen, Germany
,
J. Weis
2   Institute of Neuropathology, University Hospital RWTH, Aachen, Germany
,
J.P. Beier
1   Division of Plexus Surgery, Department for Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH, Aachen, NRW, Germany
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

We present an easy classification for nerve lesions observed in reconstructive surgery for obstetric brachial plexus palsy, performed through a supraclavicular approach and systematic exposure of nerve roots and trunks. A description of signs related to nerve traction injury (scarring, fascicular rupture, and dislocated ganglions) is combined with a grading system of microscopic tissue changes occurring in slices from traumatized nerve endings (fascicular structure, changes in perineurium and endoneurium). Both tools are proposed for any surgical brachial plexus exploration and later interaction with other professionals (pediatricians, physiotherapists, or obstetricians).

Keywords

obstetric palsy - brachial plexus - nerve traction - fibrosis - perineurium - endoneurium - minifascicles - nerve regeneration


Publikationsverlauf

Eingereicht: 30. April 2024

Angenommen: 02. April 2025

Artikel online veröffentlicht:
02. Mai 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Bahm J, Ocampo-Pavez C, Disselhorst-Klug C, Sellhaus B, Weis J. Obstetric brachial plexus palsy: treatment strategy, long-term results, and prognosis. Dtsch Arztebl Int 2009; 106 (06) 83-90
    CrossrefPubMedSuche in Google Scholar
  • 2 Lagerkvist AL, Johansson U, Johansson A, Bager B, Uvebrant P. Obstetric brachial plexus palsy: a prospective, population-based study of incidence, recovery, and residual impairment at 18 months of age. Dev Med Child Neurol 2010; 52 (06) 529-534
    CrossrefPubMedSuche in Google Scholar
  • 3 Narakas AO, Bora FW. Injuries to the Brachial Plexus. The Pediatric Upper Extremity: Diagnosis and Management. Philadelphia: W.B Saunders; 1986: 247-258
    Suche in Google Scholar
  • 4 Al-Qattan MM, El-Sayed AA, Al-Zahrani AY. et al. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol 2009; 34 (06) 788-791
    PubMedSuche in Google Scholar
  • 5 Narakas AO. Lesions found when operating traction injuries of the brachial plexus. Clin Neurol Neurosurg 1993; 95 (suppl): S56-S64
    PubMedSuche in Google Scholar
  • 6 Al-Qattan MM, Clarke HM, Curtis CG. Klumpke's birth palsy. Does it really exist?. J Hand Surg [Br] 1995; 20 (01) 19-23
    PubMedSuche in Google Scholar