“…14 a-g) among others [ 26 ]. MRI is the gold standard for glenohumeral joint evaluation, although ultrasound may be used for screening or for evaluating joint reduction in real-time [ 31 ]. Fig.…”
Mechanical birth-related injuries to the neonate are declining in incidence with advances in prenatal diagnosis and care. These injuries, however, continue to represent an important source of morbidity and mortality in the affected patient population. In the United States, these injuries are estimated to occur among 2.6% of births. Although more usual in context of existing feto-maternal risk factors, their occurrence can be unpredictable. While often superficial and temporary, functional and cosmetic sequelae, disability or even death can result as a consequence of birth-related injuries. The Agency for Healthcare research and quality (AHRQ) in the USA has developed, through expert consensus, patient safety indicators which include seven types of birth-related injuries including subdural and intracerebral hemorrhage, epicranial subaponeurotic hemorrhage, skeletal injuries, injuries to spine and spinal cord, peripheral and cranial nerve injuries and other types of specified and non-specified birth trauma. Understandably, birth-related injuries are a source of great concern for the parents and clinician. Many of these injuries have imaging manifestations. This article seeks to familiarize the reader with the clinical spectrum, significance and multimodality imaging appearances of neonatal multi-organ birth-related trauma and its sequelae, where applicable.
Teaching points
• Mechanical trauma related to birth usually occurs with pre-existing feto-maternal risk factors.• Several organ systems can be affected; neurologic, musculoskeletal or visceral injuries can occur.• Injuries can be mild and transient or disabling, even life-threatening.• Imaging plays an important role in injury identification and triage of affected neonates.Electronic supplementary materialThe online version of this article (10.1007/s13244-017-0586-x) contains supplementary material, which is available to authorized users.
“…14 a-g) among others [ 26 ]. MRI is the gold standard for glenohumeral joint evaluation, although ultrasound may be used for screening or for evaluating joint reduction in real-time [ 31 ]. Fig.…”
Mechanical birth-related injuries to the neonate are declining in incidence with advances in prenatal diagnosis and care. These injuries, however, continue to represent an important source of morbidity and mortality in the affected patient population. In the United States, these injuries are estimated to occur among 2.6% of births. Although more usual in context of existing feto-maternal risk factors, their occurrence can be unpredictable. While often superficial and temporary, functional and cosmetic sequelae, disability or even death can result as a consequence of birth-related injuries. The Agency for Healthcare research and quality (AHRQ) in the USA has developed, through expert consensus, patient safety indicators which include seven types of birth-related injuries including subdural and intracerebral hemorrhage, epicranial subaponeurotic hemorrhage, skeletal injuries, injuries to spine and spinal cord, peripheral and cranial nerve injuries and other types of specified and non-specified birth trauma. Understandably, birth-related injuries are a source of great concern for the parents and clinician. Many of these injuries have imaging manifestations. This article seeks to familiarize the reader with the clinical spectrum, significance and multimodality imaging appearances of neonatal multi-organ birth-related trauma and its sequelae, where applicable.
Teaching points
• Mechanical trauma related to birth usually occurs with pre-existing feto-maternal risk factors.• Several organ systems can be affected; neurologic, musculoskeletal or visceral injuries can occur.• Injuries can be mild and transient or disabling, even life-threatening.• Imaging plays an important role in injury identification and triage of affected neonates.Electronic supplementary materialThe online version of this article (10.1007/s13244-017-0586-x) contains supplementary material, which is available to authorized users.
“…20 Although ultrasonography is the preferred screening test in BPBI, MRI remains the standard for comprehensive glenohumeral joint evaluation and surgical decision-making. 21 The severity of glenohumeral dysplasia is graded by the Waters classification, which progresses from minimal posterior glenoid deformity, to humeral head subluxation and the development of a false glenoid, to flattening of both the glenoid and humeral head (Table 2). 22 To avoid the risks of sedation or general anesthesia, MRI may be performed without motion artifact by using the feed and wrap technique, in which infants up to 3 months of age are fed immediately before the MRI to induce natural sleep and are then swaddled with a blanket.…”
Section: Diagnostic Imaging Of the Shouldermentioning
Learning Objectives:
After studying this article, the participant should be able to: 1. Describe methods of clinical evaluation for neurologic recovery in brachial plexus birth injury. 2. Understand the role of different diagnostic imaging modalities to evaluate the upper limb. 3. List nonsurgical strategies and surgical procedures to manage shoulder abnormality. 4. Explain the advantages and disadvantages of microsurgical nerve reconstruction and distal nerve transfers in brachial plexus birth injury. 5. Recognize the prevalence of pain in this population and the need for greater sensory outcomes evaluation.
Summary:
Brachial plexus birth injury (BPBI) results from closed traction injury to the brachial plexus in the neck during an infant’s vertex passage through the birth canal. Although spontaneous upper limb recovery occurs in most instances of BPBI, some infants do not demonstrate adequate motor recovery within an acceptable timeline and require surgical intervention to restore upper limb function. This article reviews major advances in the management of BPBI in the past decade that include improved understanding of shoulder pathology and its impact on observed motor recovery, novel surgical techniques, new insights in sensory function and pain, and global efforts to develop standardized outcomes assessment scales.
“…A humeral head that realigns within the glenoid during external rotation is deemed “reducible.” A humeral head that remains posterior to the glenoid in internal and external rotation is considered “irreducible.” In our experience, ultrasound fails to reliably assess the glenoid configuration. 6…”
Section: Assessmentmentioning
confidence: 99%
“…The anterior scalene, C5 root, and subsequently the phrenic nerve are first identified and preliminarily isolated (►Fig. 6). The anesthesia team is notified to hold ventilation before the phrenic nerve is stimulated to confirm its identity via chest movement.…”
The care of children with brachial plexus birth injuries (BPBI) is a complex multidisciplinary endeavor. At the Shriners Hospital for Children in Philadelphia, we have sought to elevate the quality of care delivered to patients through outcomes research and collaboration with colleagues around the world. Our approach to the management of this challenging pathology has evolved time and again. Here, we describe our current approach to patient assessment and operative management in patients with BPBI and its many sequelae.
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