Neurosurgical correction of upper brachial plexus birth injuries

Laurent, John P.; Lee, Rita; Shenaq, Saleh M.; Parke, Julie T.; Solis, Itzel; Kowalik, Lisa

doi:10.3171/jns.1993.79.2.0197

Cited by 175 publications

(175 citation statements)

References 18 publications

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“…Surgical intervention to reconstruct injured brachial plexus nerves is performed when there is inadequate recovery of the shoulder and elbow function during the first months of life (3,27,28). Absence of biceps function is regarded as the key indication for surgical exploration (28,29).…”

Section: Treatmentsmentioning

confidence: 99%

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

Mollberg

Hagberg

Bager

et al. 2005

Acta Obstet Gynecol Scand

137

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Background: Obstetric brachial plexus palsy (OBPP) at birth is one important cause of neurological disability in children and adults; the incidence has increased substantially in Sweden over the past decade. Several risk factors for OBPP have been identified, e.g. high birth weight and shoulder dystocia, but it remains difficult to predict based on antenatally available information. Despite extensive research on OBPP, there is no generally accepted strategy for prevention. The overall objective of this thesis is to study predisposing risk factors for OBPP in vaginally delivered infants and to identify specific obstetric procedures that are strongly associated with OBPP. Based on this knowledge, our ultimate aim is to develop a prevention strategy with respect to manual assistance in the second stage of labour. Methods: Paper I reports on a retrospective case-control study aimed at investigation of the incidence and risk factors for OBPP in a large population studied in 1987-1997. All deliveries recorded in the Swedish Medical Birth Register during the period were investigated. Cases of OBPP were compared with all cases without OBPP. Paper II describes a retrospective casecontrol study, the purpose of which was to identify risk factors for OBPP, specifically in women delivered by vacuum extraction. The groups with and without OBPP were compared with regard to possible risk factors, including those linked to the vacuum extraction procedure. The aim of the prospective population-based case-control study presented in Paper III was to evaluate the association between OBPP and obstetric manoeuvres during the second stage of delivery. Obstetric management in OBPP cases was compared to management in a randomly selected control group. Paper IV and Paper III are based on the same cases. The aims of the study presented in Paper IV were a) to describe neurological deficits in children with remaining OBPP at 18 months of age; b) to compare maternal, infant and obstetric data in infants with and without OBPP at 18 months of age and c) to evaluate if differences in force applied in downward traction of the head (ranked on a 100-point visual analogue scale) correlated to the number of affected nerve roots (C5-C6, C5-C7, C5-Th1). Results:The incidence of OBPP in Sweden increased from 0.17% to 0.27% between 1987 and 1997. Infants with high birth weight, especially >4500 g, were at increased risk of shoulder dystocia and OBPP. However, high birth weight was not or only weakly overrepresented among children with persistent OBPP, compared with those who recovered, suggesting that other factors are important. Hence, many factors related to prolonged second stage and difficulties in delivering the shoulders were overrepresented in the OBPP group, compared to controls. In particular, forceful downward traction applied to the head after the fetal third rotation represented an important risk factor for OBPP in cephalic-presentation vaginal deliveries. Downward traction of the head had been applied more often and with greater force in the...

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Section: Treatmentsmentioning

confidence: 99%

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

Mollberg

Hagberg

Bager

et al. 2005

Acta Obstet Gynecol Scand

137

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“…Частота повреждения плечевого сплетения в родах составляет около 0,4-4 случая на 1000 но-ворожденных [1][2][3][4][5]. У 70-92 % пациентов отме-чаются легкие повреждения, которые спонтанно восстанавливаются в течение двух месяцев после родов [4,5].…”

Section: Introductionunclassified

Treatment approach to shoulder internal rotation deformity in children with obstetric brachial plexus palsy

Agranovich

Oreshkov

Mikiashvili

2018

Pediatr Traum Orthop Reconstr Surg

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Введение. Вторичные деформации плечевого сустава -наиболее частая проблема у пациентов с родовыми повреждениями плечевого сплетения. По данным A.F. Hoeksma et al. (2000), контрактуры плечевого сустава формируются у 1 / 3 детей с акушерскими параличами с отсроченным неврологическим восстановлением (более 3 недель после травмы) и у 2 / 3 пациентов с неполным восстановлением. При данном виде травмы наиболее часто наблюдается внутриротационная контрактура плечевого сустава, что обусловлено дисбалансом мышц, формированием дисплазии плечевого сустава. Цель -изучить результаты сухожильно-мышечных пластик при лечении внутриротационной контрактуры плечевого сустава у детей с последствиями родового повреждения плечевого сплетения. Материалы и методы. С 2015 по 2017 г. находились на обследовании и лечении 15 пациентов в возрасте от 4 до 17 лет с внутриротационной контрактурой плечевого сустава вследствие родового повреждения плече-вого сплетения. Проводили клиническое, рентгенологическое, физиологическое исследование (ЭМГ и ЭНМГ верхних конечностей), МРТ плечевых суставов. Результаты. По протяженности повреждения плечевого сплетения выделяли три группы пациентов: группа I (уровень С5-С6) -9 человек, группа II (уровень С5-С7) -5 человек и группа III (уровень С5-Th1) -1 паци-ент. У всех пациентов выявлены вторичные деформации плечевого сустава: II типа по Waters -у 6 пациентов (40 %), III типа -у 5 больных (34 %), IV типа -у 1 ребенка (6 %) и V типа -у 3 больных (20 %). Функцио-нальные возможности верхней конечности оценивали по шкале Mallet. При II-III типах гленохумеральной дисплазии функция плечевого сустава оценивалась преимущественно как хорошая, при IV-V типах -как плохая. Оперативное лечение было выполнено 15 пациентам в двух основных вариантах. После проведенного лечения во всех наблюдениях улучшилось самообслуживание пациентов. Заключение. Выполнение сухожильно-мышечной пластики у пациентов с внутриротационными контрактура-ми плечевого сустава вследствие родового повреждения плечевого сплетения позволяет улучшить косметиче-ский вид конечности, а также ее функцию, однако ремоделирования плечевого сустава у детей старше 4 лет не происходит.Ключевые слова: родовая травма плечевого сплетения; парез Эрба; гленохумеральная дисплазия; сухожильно-мышечные пластики.

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“…44 However, primary care providers for newborns lack the familiarity and expertise to educate guardians and monitor for patient recovery. 39,60 Recovery is often overestimated, and residual impairment is not characterized. 18,55 Pediatric peripheral nerve management is a highly specialized treatment area, with physical therapy and operative resources concentrated at multidisciplinary centers.…”

Section: Referral Processesmentioning

confidence: 99%

Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

Coroneos¹,

Voineskos²,

Coroneos

et al. 2016

PED

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OBJECT The aim of this study was to determine the volume and timing of referrals for obstetrical brachial plexus injury (OBPI) to multidisciplinary centers in a national demographic sample. Secondarily, we aimed to measure the incidence and risk factors for OBPI in the sample. The burden of OBPI has not been investigated in a publicly funded system, and the timing and volume of referrals to multidisciplinary centers are unknown. The incidence and risk factors for OBPI have not been established in Canada. METHODS This is a retrospective cohort study. The authors used a demographic sample of all infants born in Canada, capturing all children born in a publicly funded, universal healthcare system. OBPI diagnoses and corresponding risk factors from 2004 to 2012 were identified and correlated with referrals to Canada’s 10 multidisciplinary OBPI centers. Quality indicators were approved by the Canadian OBPI Working Group’s guideline consensus group. The primary outcome was the timing of initial assessment at a multidisciplinary center, “good” if assessed by the time the patient was 1 month of age, “satisfactory” if by 3 months of age, and “poor” if thereafter. Joinpoint regression analysis was used to determine the OBPI incidence over the study period. Odds ratios were calculated to determine the strength of association for risk factors. RESULTS OBPI incidence was 1.24 per 1000 live births, and was consistent from 2004 to 2012. Potential biases underestimate the level of injury identification. The factors associated with a very strong risk for OBPI were humerus fracture, shoulder dystocia, and clavicle fracture. The majority (55%–60%) of OBPI patients identified at birth were not referred. Among those who were referred, the timing of assessment was “good” in 28%, “satisfactory” in 66%, and “poor” in 34%. CONCLUSIONS Shoulder dystocia was the strongest modifiable risk factor for OBPI. Most children with OBPI were not referred to multidisciplinary care. Of those who were referred, 72% were assessed later than the target quality indicator of 1 month that was established by the national guideline consensus group. A referral gap has been identified using quality indicators at clinically relevant time points; this gap should be addressed with the use of knowledge tools (e.g., a clinical practice guideline) to target variations in referral rates and clinical practice. Interventions should guide the referral process.

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Neurosurgical correction of upper brachial plexus birth injuries

Cited by 175 publications

References 18 publications

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

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

Treatment approach to shoulder internal rotation deformity in children with obstetric brachial plexus palsy

Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system

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