Obstetric brachial plexus palsy

Abstract

Obstetrical brachial plexus palsy (OBPP) displays a stable incidence of 0.15 - 3 per 1,000 live births. Most children show good spontaneous recovery, but a recent literature reviews show that a residual deficit remains in 20% to 30% of children. Shoulder dystocia, macrosomia and instrument delivery, forceps or vacuum extraction present the greatest risk for brachial plexus injury. Caesarean section, having a twin or multiple birth mates seems to offer some protection against injury. The resulting nerve injury may vary from neurapraxia or axonotmesis to neurotmesis and root avulsion from spinal cord. In neurapraxia or axonotmetic lesions complete recovery will usually occur over the course of weeks or months. In a neurotmetic injury or in case of root avulsion, the most sever type of lesion, useful regeneration of axons cannot take place. Although we perform electromyography and imaging studies, the final decision of operation relies heavily on the clinical examination. Manual muscle testing system although reliable for examination of motor power in adults is not suited for use with infants. All patients involved in the study were evaluated using the Active Movement Scale (AMS), which greatly increases the ability to detect partial movements. The results of neurophysiological investigations in older..