Assessment of Biceps Muscle Functional Recovery as a Predictor of Outcome in Neonatal Brachial plexus Palsy

Abstract

Obstetrical brachial plexus palsy is a traction lesion of a part of the brachial plexus during delivery. According to the World Health Organization, prevalence is generally 1-2% worldwide. The aim of the study is to assess the time interval to biceps muscle functional recovery in relation to outcome in neonatal brachial plexus palsy. This study was conducted on 60 neonates admitted to the department of neonatal intensive care unit and outpatient follow up clinic of El Galaa Teaching Hospital, Cairo, Egypt with neonatal brachial plexus palsy. All cases were subjected to full history tasking, assessment of gestational age, thorough clinical examination, physical and neurologic examination of the affected upper extremity function including; motor assessment of biceps muscle by medical research council for grading muscle activity. Our results showed that C5-C6 injury was found in 42 patients (70%), C5-C6-C7 affection in 15 patients (25%) and three patients (5%) had total injury without associated Horner's syndrome. Motor assessment of biceps muscle activity at time of delivery revealed, that 10 patients (16.7%) had M0- grade, 34 patients (56.7%) had M1 grade and 16 patients (26.7%) had M2 grade. We conclude that majority of patients with neonatal obstetrical brachial plexus palsy had spontaneous recovery with normal function in the first three months of life. The time interval to biceps muscle recovery is an important prognostic factor in neonatal obstetrical brachial plexus palsy, as its failure to recover anti-gravity biceps function by 3 to 6 months of age is a poor prognostic sign.