Brachial plexus obstetrical paralysis

This article was written by Dr. Aursulesei Ruxandra, pediatric neurologist specialist with extensive experience in diagnosing and treating neurological conditions. Pediatric neurology plays an important role in the periodic neurological evaluation of premature infants, as well as of all newborns at risk of developing neurological sequelae, with the goal of early detection and treatment of any impairment of the nervous system.

What is obstetric brachial plexus palsy?

Obstetric brachial plexus palsy is a condition occurring during birth, consisting of motor and sensory impairment of the brachial plexus.

What does obstetric brachial plexus palsy look like?

• Upper-type palsy (Erb-Duchenne) - the upper limb hangs limp, inert due to paralysis of the following muscles: deltoid, biceps brachii, brachialis, brachioradialis, and is rotated medially. The child can move the fingers and flex the hand.
• Lower-type palsy (Klumpke) - the muscles of the forearm and hand are paralyzed.
• Total palsy - affects the entire upper limb, and is associated with sympathetic disturbances (Claude Bernard-Horner syndrome), vasomotor disturbances (cyanosis, edema, pallor), sensory disturbances (impairment of fine, coarse, thermal and painful exteroceptive sensitivity), and respiratory disturbances (phrenic nerve palsy)

Centrokinetic is prepared for this specialization with a team of experienced doctors and the necessary equipment for diagnosis, monitoring and treatment. Find out more about pediatric neurology and book an appointment at Centrokinetic here.

Are there risk factors for the occurrence of obstetric brachial plexus palsy?

The most important risk factor is dystocia, but other risk factors include malposition, induction of labor, vaginal delivery with certain instruments and fetal macrosomia. 

If it's not brachial plexus palsy, what else could it be?

• Cervical ribs
• Amniotic band syndrome 
• Congenital aplasia of the brachial plexus. 

How is brachial plexus palsy treated?

Treatment of newborns,  in the absence of a fracture, can begin immediately with passive movements of the upper extremity, in order to avoid contractures. If a fracture is present, initiation of passive movements can begin after 3 weeks, once the fracture has healed. Non-surgical management is indicated when there is antigravity resistance of the biceps at 3 months of age and a higher probability of recovery.

Kinetotherapy is of paramount importance in the recovery from obstetric brachial plexus palsy. It should be accompanied by bracing.

Surgical treatment is indicated in the case of absent biceps function at 3 months of age. Nerve grafting is the most commonly used microsurgical technique for repairing brachial plexus injuries, with good functional results in 60% to 80% of infants.

What is the prognosis for brachial plexus palsy?

The prognosis is determined by the degree of plexus involvement. It can range from excellent to severe. 

The severe prognosis in this period is indicated by a number of "warning signs":

• absence of rapid regression of the paralyses;
• the appearance of muscle atrophy;
• persistence of sensory and vasomotor disturbances, especially in the hand;
• the onset of limited joint movement due to contractures and retractions. 

Centrokinetic is prepared for this specialization with a team of experienced doctors and the necessary equipment for diagnosis, monitoring and treatment. Find out more about pediatric neurology and book an appointment at Centrokinetic here.