Management of Birth Brachial Plexus Injury Including Use of Distal Nerve Transfers

Abstract

Birth Brachial plexus injury continues to remain a problem despite significant care from obstetricians to prevent it. Many children show spontaneous recovery but a significant proportion do not have adequate recovery. This review article discusses, etiology, assessment, investigations and overall strategy to treat the condition. Surgical strategy consists of primary intraplexal repair as the standard of care but of late the distal nerve transfers used in adult plexus injuries are increasingly being used in infants too. We discuss the history, current usage and pros and cons of distal nerve transfers, the usage of Botulinum Toxin and finally given an overall algorithm for the management.

Location of brachial plexus birth injury affects functional outcomes in a rat model

“…The clinical implications of our findings support emphasis on movement analysis during functional tasks in treating BPBI. Following diagnosis, initial management of BPBI (at 2–3 weeks of age) typically comprises passive exercises aimed at preventing contracture and cortically reintegrating the affected limb 49,50 . In follow‐up visits, infants are assessed for spontaneous biceps recovery, internal rotation contracture, and glenohumeral congruency 49 .…”

“…Following diagnosis, initial management of BPBI (at 2–3 weeks of age) typically comprises passive exercises aimed at preventing contracture and cortically reintegrating the affected limb 49,50 . In follow‐up visits, infants are assessed for spontaneous biceps recovery, internal rotation contracture, and glenohumeral congruency 49 . In typical cases of spontaneous biceps recovery at 3 months of age, conservative treatment methods (such as passive and active mobilization exercises, sensory stimulation, and bimanual activities) are employed in place of surgery 50 .…”

“…49,50 In follow-up visits, infants are assessed for spontaneous biceps recovery, internal rotation contracture, and glenohumeral congruency. 49 In typical cases of spontaneous biceps recovery at 3 months of age, conservative treatment methods (such as passive and active mobilization exercises, sensory stimulation, and bimanual activities) are employed in place of surgery. 50 While further outcome assessment encompasses numerous methods, documented consensus is that ROM should be measured for passive and active joint movement and the Mallet score (which evaluates five functional movements) should be determined.…”

Recent Advances in the Treatment of Brachial Plexus Birth Injury

“…54 Greater functional specificity with reduced axonal misdirection and synkinesis may also be achieved with distal nerve transfers, where intraneural topography is more clearly defined. 55 Finally, a partially conducting neuroma-in-continuity in the brachial plexus is not sacrificed with distal nerve transfers, thereby preserving functioning or spontaneously recovering motor units. 56…”

Peripheral nerve traction injury. Literature review

“…За даними дос лі д жень, поширеність ушкодження плечового сплетення під час пологів становить 0,4-3,8 випадку на 1000 пологів [9]. Декілька чинників призводять до травми плечового сплетення під час пологів: великий розмір плода, тривалість пологів, використання щипців або вакуумного екстрактора, тазове передлежання плода, стан здоров'я матері, зокрема наявність гестаційного цукрового діабету або ожиріння, що збільшує ризик великого розміру плода, аномалії розвитку матки і пологових шляхів, пологова травма під час попередніх пологів [10][11][12].…”