Perinatal Brachial Plexus Palsy Research Articles

Radiographic imaging modalities for perinatal brachial plexus palsy: a systematic review.

Perinatal brachial plexus palsy (PBPP) has a wide spectrum of clinical symptoms that can range from incomplete paresis of the affected extremity to flaccid arm paralysis. Although there is a high rate of spontaneous recovery within the first two years of life, it remains challenging to determine which patients will benefit most from surgical intervention. The diagnostic and predictive use of various imaging modalities has been described in the literature, but there is little consensus on approach or algorithm. The anatomic, pathophysiological, and neurodevelopmental characteristics of the neonatal and infant patient population affected by PBPP necessitate thoughtful consideration prior to selecting an imaging modality. A systematic review was conducted using six databases. Two reviewers independently screened articles published through October 2021. Literature search produced 10,329 publications, and 22 articles were included in the final analysis. These studies included 479 patients. Mean age at time of imaging ranged from 2.1 to 12.8 months and investigated imaging modalities included MRI (18 studies), ultrasound (4 studies), CT myelography (4 studies), and X-ray myelography (1 study). Imaging outcomes were compared against surgical findings (16 studies) or clinical examination (6 studies), and 87.5% of patients underwent surgery. This systematic review addresses the relative strengths and challenges of common radiologic imaging options. MRI is the most sensitive and specific for identifying preganglionic nerve injuries such as pseudomeningoceles and rootlet avulsion, the latter of which has the poorest prognosis in this patient population and often dictates the need for surgical intervention.

Modified constraint-induced movement therapy during hospitalization in children with perinatal brachial plexus palsy: A randomized controlled trial

Study DesignProspective single-blind, randomized controlled study. IntroductionChildren with perinatal brachial plexus palsy (PBPP) have motion limitations in the affected upper extremity. Modified constraint-induced movement therapy (mCIMT) is one of the treatment options used for the improvement of the function of the affected limb. Purpose of the StudyThe purpose of this study was to compare the effect of mCIMT and conventional therapy in improving active range of motion (ROM) and functional use of the affected upper extremity in children with PBPP with injuries to upper and middle trunks in the hospital environment. Materials26 patients received conventional rehabilitation program (control group) and 13 patients participated in a mCIMT program (study group). Children had a mean age 56.3 months (range 4-10 years). The mCIMT included 1 hour therapy sessions emphasizing the affected arm use for 14 consecutive days during hospitalization. Their normal arm was also constrained for 6 hour per day. All the patients were assessed at the baseline, one day, one month, and three months after completion of therapy using active ROM, active movement scale, hand dynamometer, box and blocks test. ResultsThe mCIMT group improved more than the control group in shoulder internal rotation, forearm supination, elbow flexion active ROMs, hand grip strength, and in upper extremity function. ConclusionmCIMT has a potential to promote functional gains for children with PBPP; this approach should be widely applied within routine clinical practice.

Perinatal brachial plexus palsy based on avulsion, conservative treatment

Perinatal brachial plexus palsy based on avulsion, conservative treatment

Perspectives on glenohumeral joint contractures and shoulder dysfunction in children with perinatal brachial plexus palsy

Shoulder joint deformities continue to be a challenging aspect of treating upper plexus lesions in children with perinatal brachial plexus palsy (PBPP). It is increasingly recognized that PBPP affects the glenohumeral joint specifically, and that abnormal scapulothoracic movements are a compensatory development. The pathophysiology and assessment of glenohumeral joint contractures, the progression of scapular dyskinesia and skeletal dysplasia, and current shoulder imaging techniques are reviewed.

The effect of perinatal brachial plexus lesion on upper limb development

BackgroundDeficiency in upper limb development is a sequel of the perinatal brachial plexus palsy. The purpose of this study was to evaluate the effect of brachial plexus birth lesion on upper limb development.MethodsForty-four patients with unilateral obstetric brachial plexus palsy underwent measurements of both upper extremities. The average age at the time of evaluation was 6.8 years. Active motion was assessed using Gilbert-Raimondi, the modified MRC, and Al-Qattan scales. Paired t test was used for statistical analysis. Correlation between limb length / circumference discrepancy and age / time of surgery was assessed using Pearson correlation coefficient.ResultsA decrease in the circumference and length was observed in all limbs with brachial plexus lesion. We found a statistically significant difference between degree of hand length and width decrease and its useful and useless function. We observed a statistically significant difference in measurement: forearm length, hand length and width dependent on the type of surgical procedure (neurolysis, reconstruction). We observed no correlation between age and limb length / circumference discrepancy. We also observed no correlation between time of surgery and limb length / circumference discrepancy.ConclusionsThe decrease in dimensions of the affected limbs occurred predominantly during the period of early childhood. Disparities in dimensions are observed in both cases of deficiency of useful function of upper limb and cases in which functional efficiency appears.

Our experience with surgical treatment of perinatal brachial plexus palsy – results in different types of lesions

Perinatal brachial plexus palsies can be divided into upper (C5-C6), upper-middle (C5-C6-C7) and total injuries (C5-Th1). The study aimed to evaluate the results of surgical repair in the different types of palsies. The patient population comprised 80 children who underwent primary repair of the brachial plexus (external neurolysis, internal neurolysis, direct neurorrhaphy, nerve grafts, extraanatomical intraplexus reconstruction, extraanatomical extraplexus reconstruction). 31 patients were additionally subjected to 39 tenomioplasty procedures. Widely recognised assessment scales were used to evaluate the outcome of surgical treatment of different types of palsies in 70 patients. Good and very good post-operative function of the glenohumeral and elbow joints was demonstrated in all patients with upper palsy. In the group of upper-middle injuries, 61.5% of patients presented good and very good function of the shoulder joint and 76.9% had good function of the elbow. In subjects with total brachial plexus palsy, good function of the glenohumeral was demonstrated by 51.2%, good function of the elbow by 61% and 53.6% presented with a functionally useful hand. 1. While surgical repair may be indicated in brachial plexus injuries at all levels, it is usually inevitable in total and upper-middle palsies. 2. The surgical outcome depends on the extent of baseline damage to the brachial plexus, with the best prognosis in insolated upper palsies.

Evaluation of bone mineral density in children with perinatal brachial plexus palsy: Effectiveness of weight bearing and traditional exercises

(1) To investigate any evidence of bone mineral density (BMD) changes in children with Perinatal Brachial Plexus Palsy (PBPP). (2) To detect any relationship between these changes and the child age, weight, height, BMI, power index, gender, ethnicity, and the side affected. (3) To determine any possible effects of a designed weight bearing exercise program and the traditional one upon BMD of those children. Randomized single blind controlled trial. A convenience sampling strategy was used to obtain 45 children with unilateral PBPP. Their ages ranged from 3 to 10 years. They were randomly divided to three equal groups. Groups were, then, randomly assigned to either interventions [Weight Bearing Exercises Program (WBEP) or Traditional Exercises Program (TEP)] or to the control treatment. Dual Energy X-Ray Absorptiometry (DXA) was used to evaluate BMD for all children at entry and approximately after six months treatment period. We detected significant low entry level measurements of all BMD parameters of the affected side when compared to that of the unaffected sides (p=0.000). The mean value of the entry level calculated Z score for the affected side of all study children was equal to -1.12 ± 0.327 being in the osteopenic risk range. Furthermore, thirty children (66.7%) recorded less than (-1) Z score being in this risky range. Also, we recorded a significant improvement of all BMD parameters of the affected side after treatment in favor of the WBEP group when compared to that of the control and TEP groups (p=0.02, p=0.03 respectively for the affected both bones BMD parameter). BMD is significantly reduced in PBPP children. The retardation of bone accrual increases as the child height and weight decreases and the degree of paralysis increases. WBEP significantly promoted BMD improvement when compared to the TEP.

Assessment of the Prognostic Value of Horner Syndrome in Perinatal Brachial Plexus Palsy

The aim of this study was to evaluate the prognostic value of Horner syndrome as an indicator of preganglionic injuries of the lower part of the brachial plexus. The study investigated 18 cases of children with perinatal brachial plexus injury and coexistent Horner syndrome. The following data sets were analyzed: the degree of severity of the brachial plexus injury, the results of imaging examinations, the intraoperative view, the kind of operative treatment and the resultant hand function. On the basis of a clinical material analysis, it was established that Horner syndrome accompanying upper and upper-middle brachial plexus injuries has no prognostic importance. In total injuries the presence of this syndrome is not a definite proof of preganglionic injury to the C8-Th1 roots of the spinal nerves.

The Results of Surgical Treatment of the Forearm Deformity in Perinatal Brachial Plexus Palsy

The Results of Surgical Treatment of the Forearm Deformity in Perinatal Brachial Plexus Palsy

Perinatal brachial plexus palsy in children - etiology, classification and clinical picture of injuries

Perinatal brachial plexus palsy in children - etiology, classification and clinical picture of injuries

Brachial Plexus Injury in the Newborn

Brachial plexus palsy in the neonate is classified according to the anatomic location and type of injury. Upper plexus lesions are observed most frequently. The overall rate of perinatal brachial plexus palsy (PBPP) has remained stable for the last 3 decades, although risk factors for the injury are well described. The true rate of full recovery after PBPP remains controversial. Knowledge of an infant's PBPP classification can assist in predicting long-term outcome. A thorough physical examination is essential to make the diagnosis, evaluate for comorbidities, determine the treatment plan, and assess the need for referral. Additional investigations typically are not indicated. Initial management of the infant who has PBPP includes parent counseling, physical or occupational therapy, and clinical observation of the infant. A proportion of affected infants eventually requires surgical intervention or alternative therapeutic approaches, including botulinum toxin injections.

Perinatal brachial plexus palsy

Perinatal brachial plexus palsy (PBPP) is a flaccid paralysis of the arm at birth that affects different nerves of the brachial plexus supplied by C5 to T1 in 0.42 to 5.1 infants per 1000 live births. To identify antenatal factors associated with PBPP and possible preventive measures, and to review the natural history as compared with the outcome after primary or secondary surgical interventions. A literature search on randomized controlled trials, systematic reviews and meta-analyses on the prevention and treatment of PBPP was performed. EMBASE, Medline, CINAHL and the Cochrane Library were searched until June 2005. Key words for searches included 'brachial plexus', 'brachial plexus neuropathy', 'brachial plexus injury', 'birth injury' and 'paralysis, obstetric'. There were no prospective studies on the cause or prevention of PBPP. Whereas birth trauma is said to be the most common cause, there is some evidence that PBPP may occur before delivery. Shoulder dystocia and PBPP are largely unpredictable, although associations of PBPP with shoulder dystocia, infants who are large for gestational age, maternal diabetes and instrumental delivery have been reported. The various forms of PBPP, clinical findings and diagnostic measures are described. Recent evidence suggests that the natural history of PBPP is not all favourable, and residual deficits are estimated at 20% to 30%, in contrast with the previous optimistic view of full recovery in greater than 90% of affected children. There were no randomized controlled trials on nonoperative management. There was no conclusive evidence that primary surgical exploration of the brachial plexus supercedes conservative management for improved outcome. However, results from nonrandomized studies indicated that children with severe injuries do better with surgical repair. Secondary surgical reconstructions were inferior to primary intervention, but could still improve arm function in children with serious impairments. It is not possible to predict which infants are at risk for PBPP, and therefore amenable to preventive measures. Twenty-five per cent of affected infants will experience permanent impairment and injury. If recovery is incomplete by the end of the first month, referral to a multidisciplinary team is necessary. Further research into prediction, prevention and best mode of treatment needs to be done.

Perinatal brachial plexus palsy

Perinatal brachial plexus palsy (PBPP) has been traditionally classified into three types: upper plexus palsy (Erb's) affecting the C5, C6, and +/- C7 nerve roots, lower plexus palsy (Klumpke's) affecting the C8 and T1 nerve roots, and total plexus palsy. Although most cases will resolve spontaneously, the natural history of the remaining cases is influenced by contractures of uninvolved muscle groups and subluxation or dislocation of the shoulder and elbow. Microsurgical nerve repair has demonstrated to provide improved outcomes compared to conservative treatment, while advancements in secondary reconstruction have offered significant improvements in the performance of activities of daily living for older children with unresolved plexus palsy.

Perinatal brachial plexus palsy.

Perinatal brachial plexus palsy (PBPP) has been traditionally classified into three types: upper plexus palsy (Erb's) affecting the C5, C6, and +/- C7 nerve roots, lower plexus palsy (Klumpke's) affecting the C8 and T1 nerve roots, and total plexus palsy. Although most cases will resolve spontaneously, the natural history of the remaining cases is influenced by contractures of uninvolved muscle groups and subluxation or dislocation of the shoulder and elbow. Microsurgical nerve repair has demonstrated to provide improved outcomes compared to conservative treatment, while advancements in secondary reconstruction have offered significant improvements in the performance of activities of daily living for older children with unresolved plexus palsy.

Neurotizations by means of the cervical plexus in over 100 patients with from one to five root avulsions of the brachial plexus

In the years 1982-1991, we treated over 100 patients with avulsion of from one to five roots in perinatal (n = 21) and traumatic (n = 81) lesions of the brachial plexus. Based on the clinical diagnosis and the surgical findings, we divided all operated patients into four groups: 1) avulsion of all roots or avulsions and disruption of the rest of the brachial plexus; 2) avulsion and disruption of one to four roots and preservation of some elements of the brachial plexus with fibrotic changes; 3) avulsion and disruption of one to three roots, with some elements showing no macroscopic changes; and 4) children with perinatal brachial plexus palsy. In cases of root avulsion, we performed neurotization from the cervical plexus, the accessory and intercostal nerves. In patients with one to three root avulsions, we have performed selective neurotization for 3 years. The best results were obtained in groups 3 and 4, but some improvement was also noted in the other groups.