Congenital Brachial Pals in the Eastern Province of Saudi Arabia

Abstract

The clinical features of 57 patients (31 males, 26 females) with congenital brachial palsy seen at the King Fahd Hospital of the University over a 5-year period are described. Delivery was difficult in 32 (56%), 20 (35%) were large babies (birth weight greater than 3,600 g), and 20 deliveries required either forceps or vacuum extraction. The presentation at delivery was vertex in 45, breech in five, and shoulder in four. Associated injuries or features, encountered in 14 cases, were fractures of the clavicle and humerus (six cases each), and skull fracture and Horner's syndrome in one patient each. The right and left sides were involved in 31 and 24 cases, respectively, and both sides in only two cases. All the muscle groups of the affected limb were most commonly involved (40%), and hand muscles alone were affected in only one patient. Although 60% of the cases presented late to the hospital, functional recovery was observed in 63%. The major predisposing factors identified in this study were technically difficult deliveries, large infants, and breech or shoulder presentation with assisted delivery. It is suggested that early identification of these factors and improvement in obstetric care of both the mothers and babies during delivery would reduce the incidence and severity of this disability.

Natural history of obstetric brachial plexus palsy: a systematic review

“…51 Thirty-four publications did not meet any of the present inclusion criteria. 11,43,44,46,49,[51][52][53][54][55]57,58,60,62,63,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] Of the remaining 42 articles, 35 met one criterion, and seven articles met two criteria (Tables III and IV). As none of the articles met three or four criteria, the protocol was changed in that a second reviewer evaluated the papers meeting two inclusion criteria.…”

Breech Presentation Deformation

“…Tracti on to the brachia l plex us or phrenic nerve during diffi cult deliveries or vagi nal bree ch deliverie s may occur , and 75% o f cases of diap hragmati c paralys is caused by birth injury have associa ted brachia l plexus pals y. [15][16][17][18] Craniofacial The head is elon gated into a dolichoc ephalic form, often with a p rominent occip ital shel f. There may be redun dant fol ds of skin in the posterior neck as a resu lt of compres sion due to ret roflexion of the head ( Fig. 42-7 ).…”

“…This can also occur during breech deliveries when the adducted arm is pulled forcefully downward to free the after-coming head, which accounts for 9% to 24% of brachial plexus palsies. [15][16][17] The lower plexus is most susceptible to injury when traction is exerted on an abducted arm, such as occurs during breech deliveries when traction is applied to the trunk or legs while the after-coming arm is fixed in abduction. 14 When traction is particularly rapid and forceful, then diffuse multifocal injury occurs, including avulsion of the roots from the cord in the most severe injuries.…”

High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population‐based study

“…The authors ascribed the reduction to improved obstetric practice (13). Subsequent reports, including two population-based studies from Sweden (10,11), have suggested an increase in the incidence, possibly due to an increase in mean birth weight (10,11,(14)(15)(16). However, the incidence in the United Kingdom and Ireland has not changed in nearly 40 years (17).…”