Primary Nerve Repair for Obstetrical Brachial Plexus Injury

Coroneos, Christopher J.; Voineskos, Sophocles H.; Coroneos, Marie K.; Alolabi, Noor; Goekjian, Serge; Willoughby, Lauren; Thoma, Achilleas; Bain, James R.; Brouwers, Melissa

doi:10.1097/prs.0000000000001629

Cited by 23 publications

(32 citation statements)

References 60 publications

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“…Risk factors were generated from a previous epidemiological study 29 and from studies in our systematic review 18 with a primary outcome of OBPI incidence or risk. [1][2][3]5,6,16,21,23,26,30,32,34,35,38,41,[47][48][49][57][58][59]62,65 Cases of macrosomia, clavicle facture, and humerus fracture were identified within all newborn records (Appendix 2).…”

Section: Variablesmentioning

confidence: 99%

“…The 1-month time point is conservative; a proportion of OBPI is neuropraxic and may resolve spontaneously by this time (35%, 95% CI 23%-48%). 18 A novel algorithm endorsed early referral for potential surgical candidates. 44 However, primary care providers for newborns lack the familiarity and expertise to educate guardians and monitor for patient recovery.…”

Section: Referral Processesmentioning

confidence: 99%

“…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. Centers and providers with high volumes of the same diagnosis (e.g., specialized centers) generally deliver higher-quality care in the pediatric population.…”

Section: Referral Processesmentioning

confidence: 99%

“…7 Primary care providers can underestimate the injury, failing to objectively characterize residual impairment 44 and providing guardians with inaccurate information and education. 9,18 This results in guardian distress and delayed specialist referral. 44 While the benefits of early referral have been investigated internationally, 44 the proportion of infants referred to multidisciplinary centers and the process indicators for doing so have not been established.…”

mentioning

confidence: 99%

“…4 Neuropraxic injuries are expected to completely recover by 1 month; 4,7,12,66 beyond 1 month, recovery is not expected to be complete. 4 The selection of 3 months for a "satisfactory" designation was based upon our meta-analysis 18 and existing surgical algorithms, 7,12 which support operative indications beginning at 3 months.…”

mentioning

confidence: 99%

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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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Section: Variablesmentioning

confidence: 99%

Section: Referral Processesmentioning

confidence: 99%

Section: Referral Processesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Coroneos¹,

Voineskos²,

Coroneos

et al. 2016

PED

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An Update on the Management of Neonatal Brachial Plexus Palsy—Replacing Old Paradigms

et al. 2018

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restoration of function. Primary care physicians are the initiators of care for this pathology and can provide a major benefit on the outcomes. Surgery is but one part of the multidisciplinary care of NBPP. Primary care physicians, nerve surgeons, physiatrists, and occupational and physical therapists must partner to change the paradigm and provide high-quality care to neonates and children affected by NBPP.

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Peripheral nerve decompression for pain relief in the setting of previous obstetrical brachial plexus injury: a retrospective case series

Gormley,

Isak,

Gjertsen

et al. 2024

Childs Nerv Syst

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In children with previous obstetrical brachial plexus injury (OBPI) upper extremity pain is present in 45 to 66% of patients. Recent literature reports this as musculoskeletal or neuropathic in nature. The purpose of the study is to demonstrate that peripheral nerve decompression and neurolysis may be an effective treatment for patients with upper extremity pain in the context of previous OBPI. MethodsA retrospective chart review was performed on patients undergoing peripheral nerve decompression and neurolysis after OBPI by senior author. The primary outcome assessed was pain and secondary outcome measure was range of motion of the wrist and elbow. Outcome measures were assessed preoperatively as well as at their subsequent follow-up. ResultsSix patients were included, with a mean age of 14 years old at time of decompression. Three patients underwent median nerve, two patients underwent ulnar nerve and one patient underwent posterior interosseous nerve decompression. There was a substantial improvement in pain post-operatively, demonstrated by reduction or resolution of subjective pain in all patients and resolution of Tinel's sign.There was a modest improvement in range of motion. ConclusionThis study demonstrates an improvement in subjective pain and range of motion after decompression and neurolysis in OBPI patients with peripheral neuropathy. Appropriate identi cation of this pathology through routine follow-up with a multidisciplinary clinic allows for early recognition and symptom relief.Future research should focus on assessment and treatment of pain in this population on a larger scale.

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Primary Nerve Repair for Obstetrical Brachial Plexus Injury

Abstract: Therapeutic, IV.

Cited by 23 publications

References 60 publications

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

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

An Update on the Management of Neonatal Brachial Plexus Palsy—Replacing Old Paradigms

Peripheral nerve decompression for pain relief in the setting of previous obstetrical brachial plexus injury: a retrospective case series

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