Birth brachial plexus palsy: a race against time

Abstract

A 5-year-old child presented to us with weakness of the left upper limb since birth. With the given history of obstetric trauma and limb examination, a diagnosis of birth brachial plexus palsy was made. Brachial plexus exploration along with microsurgery was performed at the same time which included extrinsic neurolysis of the roots and trunks and nerve transfer for better shoulder external rotation and elbow flexion. Both the movements were severely restricted previously due to co-contractures with the shoulder internal rotators and triceps. The problem of birth brachial plexus palsy is proving to be a global health burden both in developed countries and in developing countries such as India. The lack of awareness among the general public and primary healthcare providers and inadequate orthopaedic and neurosurgeons trained to treat the condition have worsened the prognosis. This case lays stress on the delayed complications in birth brachial palsy and its effective management.

Prevalence of perinatal factors in infants with brachial plexus birth injuries and their association with injury severity

“…Perhaps the most important clinical application of this study's ndings is that it provides additional guidance to healthcare providers regarding perinatal factors that should prompt early referral to BPBI provider. Although no conclusive evidence exists for the association between BPBI outcomes and timing of referral, early evaluation by a BPBI practitioner, ideally a multidisciplinary clinic, is recommended by BPBI providers, [16][17][18]34 the American College of Obstetrics and Gynecology, 19 American Academy of Pediatrics, 20 and the Canadian Obstetrical Brachial Plexus Injury practice guidelines. 21 Expert consensus indicates that early referral allows caregiver education, 40 serial assessments for spontaneous recovery and making treatment decisions 41 and timely operative intervention.…”

“…15 To facilitate early intervention and allow providers adequate time for serial physical exams, making treatment decisions, and counseling caregivers, referral to a BPBI provider within the rst few months of life is recommended. [16][17][18][19][20][21] Although the exact mechanism of BPBI has not been de nitively elucidated, several perinatal factors have been associated with BPBI, including multi-parity, gestational diabetes, fetal macrosomia, fetal malposition, instrumented delivery, shoulder dystocia, and birth asphyxia. 1,2,19,22−25 Much of our recent understanding of these factors comes from investigations using large administrative datasets, including insurance claims or state health databases that evaluate factors associated with BPBI at the population level.…”

Initial Challenges and Opportunities for the Parents of Children Born with ERB's Palsy in Rural and Urban Areas of Punjab, Pakistan

“…Among these factors is shoulder dystocia, a condition in which the infant's shoulder becomes lodged behind the mother's pubic bone during delivery, leading to potential nerve damage (Estrella, 2021). Another contributing factor is macrosomia, which refers to an abnormally large infant, often weighing more than 4,000 grams (Patra et al, 2016). Gestational diabetes, a condition characterized by high blood sugar levels during pregnancy, has also been identified as a risk factor for Erb's Palsy.…”

“…The unfortunate consequence of impaired upper extremity function, a distressing condition known as Erb's Palsy, is a burden that afflicts patients with a lasting impact on their lives (Estrella et al, 2021). The resulting lifelong impairment not only hampers their physical abilities but also takes a toll on their overall well-being, leaving them with a diminished quality of life and a sense of diminished self-worth (Xue, et al, 2018;Yarfi, 2019;Patra, et al, 2016). The toll of this predicament manifests in various facets of their existence -their physical well-being, mental equilibrium, emotional stability, behavioural patterns, and even their financial standing (Mazhar, et al, 2019).…”

The Role of Virtual Reality and Functional Electrical Stimulation on a Seven-Year-Old Child With Erb's Palsy: A Case Report

“…When the brachial plexus (C5, C6), which innervates the arm, is severed, the condition is called Erb's palsy. This leads to an internally rotated shoulder and a pronated forearm, which is sometimes referred to as the "waiter's tip" [ 1 ]. The most frequent cause, dystocia (linked to challenging breech and forceps deliveries), can result in partial or complete paralysis depending on the extent of nerve damage, which can range from bruising to ripping.…”