Obstetrical brachial plexus injury

Abstract

Obstetric brachial plexus palsy (OBPP) is a potentially devastating form of cervical nerve injury that frequently leads to significant physical disability and occurs in 0.38 to 2.6 births per thousand. The overall incidence of birth injuries has declined with improvements in obstetrical care and prenatal diagnosis, although a hardcore of 1/1000 birth still is considered inevitable. Brachial plexus injuries at birth can be caused by various mechanisms, due to fetopelvic disproportion, causing shoulder dystocia. The use of obstetrical instrumentation during delivery is the consequence of such an event and should not be regarded as the cause of OBPP, especially in medico-legal issues. Often the diagnosis is delayed or ignored and the management of these lesions has been historically conservative, with observation and physical therapy as the primary modalities of treatment. However, more direct and invasive approaches are often desirable, and consist in primary surgery (nerve microreconstruction) and/or bone, tendon and muscle secondary procedures.