Prognosis and early management of birth injuries to the brachial plexus.

Abstract

SummaryTwenty-four cases of birth injury to the brachial plexus were seen in 21 infants over 15 years. Obstetric complications were common, and in 11 cases traction was needed to deliver the shoulders. Three out of every four arms fully recovered after exercises. Splints were not needed. Reconstructive procedures were performed on three permanently paralysed arms when the children were aged about 4. There was no way of predicting which patients would recover. The muscles supplied by the suprascapular nerve were paralysed in all patients, and this paralysis persisted in those whose arms failed to recover fully.

Natural history of obstetric brachial plexus palsy: a systematic review

“…The validity of this somewhat arbitrary limit is borne out by reports describing a steady functional state after two to three years. 4,10,74,90 Only two authors reported ongoing recovery after this period, in sporadic cases. 102,107 Additionally, neurological examinations become more accurate as children get older because of their increased ability to cooperate.…”

Obstetrical Lesions of the Brachial Plexus

“…Obstetrical paralysis of the brachial plexus has been reported in 0.2-2.5% of births [Adler and Patterson, 1967;Bennet and Harrold, 1976;Gagnaireet al, 1975;Merger and Judet, 1973;Tan, 1973;Thoulon and Varnier, 1974;Vassal os et al, 1968]. It occurs in decreasing order of frequency as paralysis of the upper plexus, total paralysis and paralysis of the lower plexus.…”

“…The percent of spontaneous recovery var ies from 40 to 75% [Bennet and Harrold, 1976;Czurda andMeznik, 1977;Tan, 1973]. Some authors report an improvement or even complete recovery within the first weeks of life for most babies [Tan, 1973;Thoulon and Varnier, 1974], Sometimes, however, recovery, when it does occur is evi dent only at 1-1 'h' years of age [Adler and Patterson, 1967;Bennet and Harrold, 1976;Gordon et al, 1973].…”

“…Some authors report an improvement or even complete recovery within the first weeks of life for most babies [Tan, 1973;Thoulon and Varnier, 1974], Sometimes, however, recovery, when it does occur is evi dent only at 1-1 'h' years of age [Adler and Patterson, 1967;Bennet and Harrold, 1976;Gordon et al, 1973]. In a study of 103 cases reviewed when the subjects reached adult hood, 40 subjects were capable of using the affected limb well, 30 had very limited use of the limb and in the remainder a moderately serious paralysis persisted [Gjorup, 1976].…”

“…It occurs in decreasing order of frequency as paralysis of the upper plexus, total paralysis and paralysis of the lower plexus. It usually occurs in long or traumatic deliveries [Eng, 1971;Gagnaire et al, 1975;Thoulon and Varnier, 1974]; often the baby's weight is above normal [Bennet and Harrold, 1976;Eng. 1971;Thoulon and Varnier.…”