Obstetric Palsy Research Articles

Posterior dislocation of the humeral head in association with obstetric paralysis.

Twelve children with obstetric paralysis were diagnosed as having a posterior dislocation of the humeral head. The diagnosis was suspected on clinical grounds and confirmed by computed tomography (CT) scans in all cases. All 12 patients were treated with open reduction via an anterior approach. The age range at the time of surgery was from 7 months to 7 years (average, 2 years and 3 months). All patients were immobilized in a shoulder spica for 6 weeks and a further 6 weeks in an orthosis. All patients were examined by CT scans in the postoperative period, which confirmed a satisfactory reduction in all cases. With a minimal follow-up of 12 months, there have been no redislocations. This article demonstrates that dislocation of the shoulder in association with obstetric paralysis is not rare, as previously described, and shows that once diagnosed, the dislocation can be satisfactorily treated by a single anterior open reduction of the shoulder.

Posterior Dislocation of the Humeral Head in Association with Obstetric Paralysis

Posterior Dislocation of the Humeral Head in Association with Obstetric Paralysis

分娩麻ひ 予後予測と治療

分娩麻ひ 予後予測と治療

Standardisation of the evaluation and classification of the clinical features in obstetric palsies.

The classification of miscellaneous clinical features in obstetric palsies is difficult due to variations during growth, regeneration, plexus repair and secondary surgery. Any useful comparison of different forms of therapy requires universally recognised norms of evaluation. Several proposals have already found clinical application. Their employment will help to unify the results of our evaluation.

Results of microsurgical reconstruction and secondary surgery for obstetric palsies of the brachial plexus.

Since the development of microsurgical methods, the timing and concepts of surgery have significantly changed in obstetrical palsies. Because of the high axon regeneration potential in children, early and successful microsurgical reconstruction of the brachial plexus provides very encouraging results. Such successful nerve regeneration is the basis for secondary surgery which aims at complete restoration of function of the upper limb.

Obstetric brachial plexus palsy with anterior dislocation of the shoulder

Anterior dislocation of the shoulder is rarely associated with obstetric paralysis. Liebolt and Furey’ reported an antero-inferior dislocation that presented 7 months after birth; Babbit and Cassidyz treated infants with obstetric paralysis who had anterior dislocation of the involved shoulder; and Ingram” described an infraglenoid dislocation following use of an ‘aeroplane splint’ for obstetric paralysis. We present a case of Erb’s palsy” which received physiotherapy (passive abduction and lateral rotation) to prevent contracture and presented at the age of 6 months with an antero-inferior dislocation of the shoulder.

Results of secondary shoulder surgery in obstetric paralysis

Results of secondary shoulder surgery in obstetric paralysis

Transplantation of vascularized latissimus dorsalis flaps to the deltoid region for children with obstetrical brachial paralysis sequela

Bipolar transplantation of vascularized pedicle flaps from the latissimus dorsalis to the deltoid region was done in 25 children between the ages of 2 and 14 years. All had sequela of obstetrical brachial plexus paralysis with various degrees of internal rotation contracture. Pre-operative limitation of active abduction ranged 0 to 80 degrees (mean=56 degrees). Muscle transplantation was supplemented in all cases by other musculotendinous and osteoarticular procedures. The surgical procedure and postoperative management are described in detail. All children showed improvement of arm function and shoulder range of motion. Post-operatively, active abduction was 20 to 170 degrees (mean=131 degrees). Internal rotation contracture was reduced and active external rotation was ebabled. There were two complications: one necrosis of the pedicle flap and one traction neuritis of the brachial plexus.

Standardization of evaluation and classification of disability manifestations in traumatic brachial plexus birth injury-induced paralysis

The classification of miscellaneous clinical features in obstetric palsies is difficult due to variations during growth, regeneration, plexus repair and secondary surgery. Any useful comparison of different forms of therapy requires universally recognised norms of evaluation. Several proposals have already found clinical application. Their employment will help to unify the results of our evaluation.

Results of brachial plexus surgery and replacement operations in traumatic brachial plexus birth injury-induced paralysis

Since the development of microsurgical methods, the timing and concepts of surgery have significantly changed in obstetrical palsies. Because of the high axon regeneration potential in children, early and successful microsurgical reconstruction of the brachial plexus provides very encouraging results. Such successful nerve regeneration is the basis for secondary surgery which aims at complete restoration of function of the upper limb.

Infantile Dislocation of the Elbow Complicating Obstetric Palsy

This is a report of three cases of complete dislocation of both the radius and ulna at the elbow in infants born with obstetric palsy. All three patients had painless elbow-flexion contractures. The pathologic anatomy included (a) medial and posterior displacement of the radius and ulna on the humerus, (b) laxity of the lateral capsule and collateral ligaments, (c) contracted medial capsule and collateral ligaments, (d) contracted biceps and triceps muscles, and (e) hypoplasia of the capitellum, trochlea, coronoid process, and olecranon fossa. Open reduction was attempted in all three of these patients and was successful in two.

Infantile Dislocation of the Elbow Complicating Obstetric Palsy

Summary This is a report of three cases of complete dislocation of both the radius and ulna at the elbow in infants born with obstetric palsy. All three patients had painless elbow-flexion contractures. The pathologic anatomy included (a) medial and posterior displacement of the radius and ulna on the humerus, (b) laxity of the lateral capsule and collateral ligaments, (c) contracted medial capsule and collateral ligaments, (d) contracted biceps and triceps muscles, and (e) hypoplasia of the capitellum, trochlea, coronoid process, and olecranon fossa. Open reduction was attempted in all three of these patients and was successful in two.

Transplantation of teres major muscle for infraspinatus muscle in obstetrical palsy and irreparable tears of the rotator cuff

Transplantation of teres major muscle for infraspinatus muscle in obstetrical palsy and irreparable tears of the rotator cuff

PALLIATIVE SURGICAL PROCEDURES TO RESTORE SHOULDER FUNCTION IN OBSTETRIC BRACHIAL PALSY

Dr. Narakas intended to study a series of 61 cases of shoulder sequelae of obstetric palsy. His vast experience would have enriched our clinical knowledge of this ailment. The authors carry on with that study to clarify his therapeutic approach and share the benefit of his experience.

PS-37-9 Long latency responses to unilateral and bilateral toe-up perturbation in stroke hemiplegics

Among the conservatively treated patients with obstetrical paralysis after delivery in the vertex presentation, cross reinnervation sometimes occurs in the course of their recovery and co-contraction of multiple muscles impairs smooth upper limb motion. Such co-contraction of the biceps and the triceps inhibits normal elbow motion, making it impossible to use the elbow effectively in daily activities, despite adequate strength in these muscles. To overcome biceps/triceps co-contraction, we performed intercostal nerve transfer to the musculocutaneous nerve for three patients of age 11 months, 6 years and 9 years, respectively, and to the motor branches of the triceps for two patients of age 4 and 14 year-old, respectively. During the average follow-up period of 5.6 (range 1–11.5) years, the power of the reinnervated muscle improved to more than M3, and smooth motion of the elbow independently of shoulder motion was restored.

PS-21-4 The value of neurophysiological examination in obstetric plexus paralysis

PS-21-4 The value of neurophysiological examination in obstetric plexus paralysis

Nerve injuries due to obstetric trauma.

The incidence of nerve injuries among 32,637 deliveries over a period of ten years was 1.81/1000. Brachial plexus injury (1/1000) and facial nerve injury (0.74/1000) accounted for 98% of nerve injuries. Both the right and left side were involved equally. Bilateral nerve injury was not seen. Lack of antenatal care, macrosomia, abnormal presentations, and operative vaginal deliveries significantly increased the risk of nerve injuries. These babies had significantly higher incidence of meconium stained liquor and intrapartum asphyxia. Parity of the mother, gestational age and sex of the baby did not have significant role in the causation of nerve injuries. Injuries to brachial plexus and facial nerve were seen even in babies born by caesarean section, when it was performed for obstructed labour caused by cephalo-pelvic disproportion and abnormal presentations. Three babies with injuries expired and forty-three could be followed up for varying periods. None of the babies had residual defects. Detection of cephalopelvic disproportion and abnormal lie in the third trimester and their appropriate management would decrease the incidence of obstetric palsies to a significant extent.

Peripheral Nerve and Neuromuscular Disorders

Mononeuropathies, plexopathies, and radiculopathies may occur with increased incidence during pregnancy and the puerperium. Immunologically mediated disorders of peripheral nerve, neuromuscular junction, and muscle have distinctive management problems when they occur during pregnancy.

Derotation osteotomy of the forearm in management of paralytic supination deformity

Ten children with supination deformity of the forearm due to obstetric paralysis were treated by pronation osteotomy of the radius and ulna. In two patients release of the interosseous membrane was added. The main achievement of the operation was an improved position of rest, which rendered a mechanical advantage for the basic function of the hand in grasping medium-sized objects. Preliminary results of three other patients who recently underwent rerouting of the biceps tendon concurrently or following the osteotomy are encouraging. One patient who had both procedures underwent rerouting of the biceps, which resulted in a gain of 135o of active pronation.

Posterior dislocation of the humeral head in infancy associated with obstetrical paralysis. A case report.

Posterior dislocation of the humeral head in infancy associated with obstetrical paralysis. A case report.