Congenital Brachial Plexus Palsy Research Articles

Poster 175: The Use of Craniosacral OMT and Occupational Therapy to Improve Upper Extremity Function in Congenital Brachial Plexus Palsy: A Case Report

PM&RVolume 10, Issue 9S1 p. S59-S59 Poster 175: The Use of Craniosacral OMT and Occupational Therapy to Improve Upper Extremity Function in Congenital Brachial Plexus Palsy: A Case Report Alexandra Samas DO, Alexandra Samas DO SUNY At Stony Brook, Port Jefferson, NY, United StatesSearch for more papers by this authorKalliopi Kapsalis Nestor MD, Kalliopi Kapsalis Nestor MDSearch for more papers by this author Alexandra Samas DO, Alexandra Samas DO SUNY At Stony Brook, Port Jefferson, NY, United StatesSearch for more papers by this authorKalliopi Kapsalis Nestor MD, Kalliopi Kapsalis Nestor MDSearch for more papers by this author First published: 26 September 2018 https://doi.org/10.1016/j.pmrj.2018.08.187Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, Issue9S12018 AAPM&R Annual Assembly AbstractsSeptember 2018Pages S59-S59 RelatedInformation

Congenital brachial plexus palsy

Abstract Congenital brachial plexus palsy (CBPP) occurs secondary to traumatic injury to the brachial plexus in the perinatal period. It is a commonly encountered problem on the postnatal wards with the potential for significant morbidity. Previously termed ‘obstetrical brachial plexus palsy', recent evidence suggests that it may occur independently of the actions of the birth attendant in some cases. Significant risk factors include shoulder dystocia, macrosomia, instrumental delivery and prolonged second stage of labour. Prognosis is variable and dependent on the type and level of nerve injury with total plexus palsies having the worst prognosis. Approximately two thirds of patients will have complete and spontaneous recovery by 6 months of age. However in those with residual defects, secondary complications may develop. It is important to diagnose it early and manage appropriately due to the risk of long term neuromuscular dysfunction and deformities in the affected arm in some cases. Management following recognition involves, prompt paediatric review and exclusion of associated injuries such as bony fractures. Urgent and regular physiotherapy input is crucial in preventing complications and monitoring progress. Primary surgical repair may be indicated in cases that do not or are unlikely to recover and prompt and early referral to a specialist centre is recommended in these difficult cases. Secondary surgery may also be indicated in those who develop complications. This review details the pathophysiology, risk factors and classification of CBPP. It suggests a systematic approach to the diagnosis of CBPP and gives a framework for understanding its management and prognosis.

Technique for shoulder ultrasonography in infants with congenital brachial plexus palsy

Technique for shoulder ultrasonography in infants with congenital brachial plexus palsy

Technique for shoulder ultrasonography in infants with congenital brachial plexus palsy

BACKGROUND Glenohumeral instability is a known complication of congenital brachial plexus palsy. In certain cases, muscle imbalance leads to posterior displacement of the head of the humerus on the cartilaginous glenoid, resulting in glenoid dysplasia and varying degrees of joint subluxation. Studies using ultrasonography have demonstrated that these anatomical changes occur in the early months of life and can be reversed with prompt treatment. However, the technical challenge of obtaining standard ultrasonography in a child a few weeks old is considerable. The subject is small, mobile and unable to sit unsupported. The shoulder that is being examined must be fully exposed with the upper limb free to move in order to obtain dynamic imaging. We had previously tried several methods of supporting the baby in order to facilitate the examination to no avail until it occurred to us to use a simple proprietary seating aid.

Congenital lower brachial plexus palsy due to cervical ribs

Congenital brachial plexus palsy (CBPP) usually occurs secondarily to intrapartum trauma, but this is not always the case. Cervical ribs have previously been reported to increase the risk of CBPP in association with birth trauma. We report the cases of two children (one female, one male) with congenital lower brachial plexus palsy in whom the presence of non-ossified cervical ribs was the only identified risk factor. In the female child magnetic resonance imaging (MRI) of the brain, spinal cord, and brachial plexus revealed no abnormality except for the presence of bilateral cervical ribs at the level of the seventh cervical (C7) vertebra. Chest radiography was normal, which suggested that the cervical ribs identified on the MRI were fibrous bands or cartilaginous ribs rather than ossified ribs. In the male child, MRI of the spine and brachial plexus was normal but he was noted to have bilateral cervical ribs at C7. These were not identifiable on chest radiography and, therefore, are likely to reflect fibrous bands or cartilaginous ribs.

Severe chronic morbidity following childbirth

Three special, chronic morbidities of childbirth are reviewed with the most up-to-date knowledge in this article. Firstly, obstetric fistulas secondary to prolonged obstructed labour are still prevalent tragedies in underdeveloped countries. The damage is not only physical but psychosexual and social. The surgical skill and technology required to prevent and to treat obstetric fistulas are simple, but culture-social antagonism, geographic distance, political instability and financial constraint have to be overcome before effective management can take place. Congenital brachial plexus palsy is associated with shoulder dystocia and macrosomia, and both excessive exogenous traction and strong endogenous pushing forces contribute to its occurrence. As shoulder dystocia and macrosomia are not easily predictable, regular training and drill is essential to ensure proper management of shoulder dystocia. Most of the babies with brachial palsy will recover in 3 months but a minority of patients will suffer a more severe degree of damage, requiring early micro-neurosurgical intervention. Finally, although birth asphyxia is not the major cause of cerebral palsy, brain injury resulting from acute intrapartum hypoxic-ischemic insult is potentially alleviated by early neonatal hypothermic therapy. Both clinical and radiological assessments are essential in selecting suitable candidates for this innovative neuroprotective strategy.

Management of birth brachial plexus palsy

The indications for surgical repair of congenital brachial plexus palsy are controversial. Our objective was to determine the results of early brachial plexus surgery following obstetric-induced brachial plexus palsy. We performed a retrospective analysis of the outcome of 58 cases of brachial plexus surgery. The indication for operation consisted of the presence of less than antigravity strength in the biceps, triceps, and deltoid muscle groups at 6 months of age. Data gathered prospectively, previously, showed the likelihood of improvement with less than antigravity strength in these cases to be poor. Follow-up data were obtained on 52 of the 58 cases. Overall mean follow-up was 2 years. Twelve patients had more than 3 years follow-up (mean 5.5 years, range 3-11.5 years). Significant improvement was seen in all injury patterns i.e., C5-C6, C5-C7, and C5-C8, T1. Greater than antigravity strength in the biceps, triceps, and deltoid muscle groups was seen in the majority of cases at follow-up. Repair of obstetrical brachial plexus palsy in children at 6 months of age that is based on less than antigravity strength in the biceps, triceps, and deltoid muscle groups produces improvement in functional capabilities. Children with obstetrical brachial plexus palsy should be referred soon after birth to a center that specializes in the treatment of this type of palsy.

Poster 45: Upper-Limb Coordination in Children With Congenital Brachial Plexus Palsy

Objective: To determine if affected arm reaching in children with congenital brachial plexus palsy (CBPP) improves when both arms perform the same task simultaneously. Design: Descriptive measurement study. Setting: Motor control laboratory. Participants: 7 control and 7 CBPP subjects with mild to moderate functional impairment. Interventions: Not applicable. Main Outcome Measures: Spatiotemporal characteristics of forward reaching. Movement speed and handpath trajectories were analyzed during unilateral, bilateral, and bilateral movements. Results: Across conditions, CBPP subjects moved more slowly than controls (P<.01). During unilateral reaching, the affected arm was significantly slower than the unaffected arm (P=.02). When in-phase, bilateral reaches were made, however, affected arm speed increased compared with the unilateral condition. This improvement was not evident during bilateral movements made in opposite directions (antiphase). Movement trajectories of both arms in CBPP subjects were consistently more variable than controls, regardless of condition. Conclusions: Multijoint coordination is compromised in CBPP, although bilateral tasks involving simultaneous activation of similar muscle groups (in-phase coupling) may improve the speed of motor performance in the affected arm. Impaired coordination may reflect central nervous system changes as a result of decreased arm usage, which may be reversible after task-based training.

Abstract 19: Bilateral Facilitation of Upper-Limb Movements in Children With Congenital Brachial Plexus Palsy

Abstract 19: Bilateral Facilitation of Upper-Limb Movements in Children With Congenital Brachial Plexus Palsy

Congenital brachial plexus palsy: Where have we been and where are we now?

Congenital brachial plexus palsy: Where have we been and where are we now?

Clinical assessment, MRI, and EMG in congenital brachial plexus palsy

Thirteen infants with congenital brachial plexus palsy (eight with upper, five with upper and lower) were monitored by magnetic resonance imaging (the first performed between 7 and 41 days of age and the second at 3 months of age), electromyography (the first performed between 27 and 50 days and the second at 3 months), and the muscle scoring system of the Hospital for Sick Children (at 3, 6, and 9 months of age). The findings were evaluated with respect to the clinical status of the patients at 12 months of age. Magnetic resonance imaging, which could be performed readily even in the neonatal period, revealed pseudomeningoceles in two of the five patients with a poor prognosis (in all planes even in the early days after birth) and in two of the eight patients with a good prognosis (more easily visible at 3 months of age). Electromyography implied root avulsion in three of five patients with a poor prognosis. Electromyography can be of great value for patients with a poor prognosis and root avulsion but may underestimate the severity. The muscle scoring system (Hospital for Sick Children) was determined to be the most predictive method for prognosis.

The timing of congenital brachial plexus injury: A study of electromyography findings in the newborn piglet

Objective: Permanent congenital brachial plexus palsy is a recognized serious complication associated with shoulder dystocia. The timing and etiology of this injury remains controversial. Previous authorities have used adult-derived, non–brachial plexus data to extrapolate the anticipated timing for electromyographic denervation changes to date such injuries in the newborn. With use of a domestic swine model, this investigation tests the hypothesis that electromyographic evidence of brachial plexus denervation in the newborn is temporally different than that in the adult. Study Design: Five healthy 2-day-old and two adult pigs underwent unilateral sharp transection of the brachial plexus. Daily electromyographic studies were performed in brachial plexus innervated muscle groups on the involved and contralateral (control) front limbs. Postmortem measurements of the transected nerve segments were obtained in one piglet and one adult animal. Representative hard copy recordings of individual electromyographic studies were collected. Results: Immediately after surgical transection of the brachial plexus, no electromyographic evidence of denervation was observed. Uniformly in the newborn piglets, at 24 hours after transection, denervation in the form of fibrillation potentials, positive sharp waves, and complex repetitive discharges was seen. Serial testing demonstrated proximal to distal gradients of denervation over the next 24 to 48 hours. A delay in electromyographic evidence of denervation was observed in the two adult pigs until days 5 and 8, respectively. Control limb studies remained normal throughout the study period. Nerve length measurements for individual muscle groups were as follows for the adult and newborn pigs, respectively: deltoid 11.4 cm, 2.5 cm; cleidobrachialis 16.0 cm, 4.0 cm; triceps 15.5 cm, 4.5 cm; forelimb flexors 26.0 cm, 6.5 cm; and extensor carpi radialis 31.0 cm, 9.0 cm. Conclusion: Electromyographic evidence of brachial plexus denervation after surgical transection differs between the newborn and the adult pig. Consistent with wallerian degeneration, a correlation exists between length of the distal nerve segment and timing for electromyographic signs of denervation. These findings suggest it would be inappropriate to extrapolate the anticipated timing for electromyographic changes in the newborn on the basis of previously established adult non–brachial plexus data. (Am J Obstet Gynecol 1998;178:688-95.)