Type your tag names separated by a space and hit enter

    Perinatal Brachial Plexus Palsy

    Perinatal Brachial Plexus Palsy is a topic covered in the Select 5-Minute Pediatrics Topics.

    To view the entire topic, please or purchase a subscription.

    Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

    Medicine Central

    -- The first section of this topic is shown below --

    Basics

    Description

    • The brachial plexus contains sensory and motor nerves to the upper extremities, stemming from the cervical and thoracic spine (commonly C5–T1 roots).
    • The brachial plexus contains a consistent pattern of nerves that innervate predictable muscles and skin regions.
    • Brachial birth palsy is a proximal stretch, avulsion, or rupture type injury and may involve
      • C5–C6 (Erb palsy), most common, best prognosis
      • C5–C7, less common, worse prognosis
      • C5–T1, least common, flail extremity and worst prognosis

    Epidemiology

    • There is no predominance of gender, but variations in clinical care, preventive measures, and birth weight may explain estimates of incidence to range from 0.4 to 4 per 1,000 live births.
    • Incidence drops from 0.2% with vaginal delivery to 0.02% after cesarean section as there is a probable mechanical basis for the plexopathy.
    • Erb palsy is the most commonly encountered plexus injury.

    Risk Factors

    • Large size for gestational age, multiparity, prolonged labor, breech position, difficult delivery—especially when forceps- or vacuum-assisted
    • Diabetic mothers and/or neonatal birth weight >4.5 kg
    • Although there is no genetic basis per se, previous delivery leading to obstetric palsy is a risk factor.

    General Prevention

    • Careful positioning of the upper extremity during childbirth and conversion to cesarean section when necessary
    • Prevention of long-term disability and contracture can be minimized with exercise of the child’s joints and functioning muscles every day beginning at 3 weeks of age.

    Pathophysiology

    • Seddon and Sunderland have described classification systems to describe degree of injury.
      • Neuropraxia
        • Mildest form, interruption of conduction, axons continuous
        • Good recovery
      • Axonotmesis
        • Axonal degeneration with loss of axonal continuity
        • Nerve intact. Epineurium and perineurium intact.
      • Neurotmesis
        • Most severe, nerve is completely contused. Axonal discontinuity
        • Nerve may be grossly intact, but epineurium, perineurium, and axons disrupted. Recovery difficult to predict.

    Etiology

    • Downward mechanical force on the shoulder during difficult delivery can lead to stepwise stretch injury leading to transient or permanent damage or total avulsion of nerve roots.
    • Upward mechanical force, that is, after face delivery, leads to C8–T1 injury (Klumpke).
    • Avulsion injury carries the worst prognosis, particularly if proximal to the cell body of the motor nerve (preganglionic), as these injuries cannot spontaneously recover.

    Associated Injuries

    • Horner syndrome, phrenic nerve injury, and long thoracic nerve injury (winged scapula) may be observed and are associated with preganglionic injury and a poor prognosis.

    -- To view the remaining sections of this topic, please or purchase a subscription --

    Citation

    * When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Perinatal Brachial Plexus Palsy ID - 14121 ED - Cabana,Michael D, BT - Select 5-Minute Pediatrics Topics UR - https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14121/all/Perinatal_Brachial_Plexus_Palsy PB - Wolters Kluwer Health ET - 7 DB - Medicine Central DP - Unbound Medicine ER -