A brachial plexus injury bpi, also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand. Injury to the brachial plexus is most commonly caused by stretching. Erbs palsy brachial plexus birth palsy erbs palsy is a form of brachial plexus palsy. Brachial plexus birth injury, also known as brachial plexus injury, is an injury to the brachial plexus nerves that occurs in about one to three out of every 1,000 births. In the event of pan plexus palsy, your arm will not function at all, including the hand, wellons said. The classic presenting features of obstetric brachial plexus palsy include atrophied muscles of the hands, symptoms of horner syndrome to include ptosis of the eyes and face. In contrast, klumpkes, or klumpkedejerine palsy, affects the lower roots of the brachial plexus c8, t1. The brachial plexus is a network of nerves which sends signals from the spinal cord to the upper extremities including the shoulder, arms, and hands. Pdf narakas classification of obstetric brachial plexus. Brachial plexus palsy a therapy guide for your baby 2 of 8 brachial plexus palsy is caused by trauma to the nerves of the arm. It includes assessment forms and information sheets for use in clinical practice. Part a was an interrater reliability study in which 63 infants younger than 1 year with obpp were independently. Restoration of elbow flexion in traumatic upper brachial plexus. Know the causes, symptoms, treatment and diagnosis of brachial plexus palsy.
In the late 1800s, the different types of nbpp were defined. However, newborns of all sizes can suffer a brachial plexus injury, and prediction of babies likely to be affected is often extremely difficult. Several surgeries can help with brachial plexus palsy. Glenoid version in children with obstetric brachial plexus palsy. Nath is a former assistant professor of the department of surgery and division of plastic surgery and department of neurosurgery. Neonatal brachial plexus palsy nbpp after a delivery involving shoulder dystocia is not only a clinical disasterit constitutes the second largest category of litigation in obstetrics. Prospective study of recovery following neonatal brachial plexus. Although detailed knowledge of the elements of the network is important for distinguishing between radiculopathy and mononeuropathy, a. The full text of this article is available in pdf format. Assessment of children with brachial plexus birth palsy using the.
The brachial plexus is a network of intertwined nerves that control movement and sensation in the shoulder, arm and hand. Brachial plexus palsy pediatric orthopaedic society of north america posna 1 tower ln, suite 2410 oakbrook terrace, il 60181 p. Brachial plexus birth palsy bpbp involves injury to any nerve of the brachial plexus during birth. The reliability of the active movement scale ams, a tool for assessing motor function in infants with obstetrical brachial plexus palsy obpp, was examined in 2 complementary studies. Obstetric brachial plexus palsy refers to a medical condition in which there is paralysis of the arm as a result of injury to the nerves originating behind the neck and going down the arm. A closednerve injury is initially managed conservatively and explored at 2 to 5. Our team of doctors, surgeons, physical therapists, occupational therapists, nurses and other health professionals work together closely to provide care for children of all ages with a brachial plexus palsy. Erbs palsy brachial plexus injury gym exercises duration. For infants affected by brachial plexus palsy, the surgery should be completed around sixmonths. Given the risks of permanent disability and limb deformity, optimization of diagnosis and treatment of this pediatric condition is critical. Symptoms and treatment of a brachial plexus injury. Physiotherapy protocols for the management of different types of brachial plexus injuries introduction as such, protocols in the management of brachial plexus injuries bpi are a bit of a misnomer.
A summary of the new acog report on neonatal brachial. Articles journal of brachial plexus and peripheral nerve. Brachial plexus is the network of nerves which runs through the cervical spine, neck, axilla and then into arm or it is a network of nerves passing through the cervico axillary canal to reach axilla and innervates brachium upper arm, antebrachium forearm and hand. Magnetic resonance imaging of the shoulder in children with brachial plexus birth palsy. Paralysis of the arm due to an injury to the brachial plexus. Muscular and glenohumeral changes in the shoulder after brachial plexus birth palsy. The result might be a loss of muscle function, or even paralysis of the upper. It is a somatic nerve plexus formed by intercommunications among the ventral rami roots of the lower 4 cervical. Department of pediatrics and communicable diseases, mott childrens hospital, university of michigan medical school, ann arbor, mi neonatal brachial plexus injury presents as weakness or paralysis of the upper extremity or extremities at birth, most often related to stretching of the brachial plexus in the perinatal period. This trauma may have caused muscle weakness, lack of movement, andor lack of feeling in your babys arm. Yes, and its important to discuss it with your doctor as early as possible. A brachial plexus palsy bpp affects the nerves passing from the neck to the arm.
Brachial plexus birth palsy bpbp is defined as an injury to any nerve root of the brachial plexus during difficult delivery. The presence of an injury to the brachial plexus is. The prognosis for recovery from brachial plexus injury sustained at or before birth is. Brachial plexus birth palsy occurs in as many as 3 per live births and can result in permanent nerve dysfunction, muscular weakness and paralysis, and secondary skeletal changes. The nerves of the brachial plexus may be stretched, compressed, or torn in a difficult delivery. Anatomy of the brachial plexus article pdf available in journal of pediatric rehabilitation medicine 42. Obstetric brachial plexus palsy a guide to management contents introduction 4 types of injury, severity, and associated problems and injuries 5 muscles and segmental information 6 upper limb dermatomes 8 referral pathway 9 assessment of active movement 10 initial physiotherapy advice early management guidelines for parents 15. Adult brachial plexus brachial plexus program michigan. Erbs palsy brachial plexus birth palsyorthoinfo aaos. Clinically, brachial plexus injuries can be divided according to their location into injuries of the upper plexus erbs palsy and of the lower plexus klumpkes palsy. Downloaded from subclassified into two groups according to early. Nath brachial plexus injury expert specializing in. Brachial plexus birth palsy is a flaccid weakness in an upper limb resulting from injury during birth to the brachial plexus, the group of nerves that runs from the spinal cord to the shoulder, arm and hand researchers at the brachial plexus injury program at childrens hospital of philadelphia worked with researchers in the department of obstetrics and gynecology at the university of.
Shoulder abnormalities are the major cause of morbidity in upper brachial plexus birth palsy bpbp. The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla armpit, and gives rise to nerves to the upper limb. Brachial plexus palsycausessymptomstreatmentdiagnosis. Imaging assessment of glenohumeral dysplasia secondary to. This chapter will discuss assessment, nonsurgical treatment, and surgical treatment of brachial plexus palsy. This document was developed as a practical clinical tool for therapists working with babies, children and young people with obstetric brachial plexus palsy obpp relating practice to the evidence.
Obstetric brachial plexus palsy a framework for therapy. Patients with obstetric brachial plexus palsy and upper root involvement c5c6 c7 have no shoulder abduction and external rotation because of paralysis of. Indications for peripheral nerve and brachial plexus surgery. Active movement an evaluative university of toronto. Thats where the upper part of the brachial plexus is stretched or torn, wellons explained.
Reconstruction of shoulder abduction and external rotation in. Brachial plexus injury nationwide childrens hospital. Nath is a specialist in brachial plexus injury and erbs palsy treatment surgery. The majority of the children recover with either no deficit or a minor functional deficit, but it is almost certain that some will not regain adequate limb function.
A typical brachial plexus injury may have a combination of the above. Also affiliated with the texas medical center in houston and the texas medical school northwestern university medical school chicago il. Newborns with peripheral nerve lesions involving the upper extremity are difficult to evaluate. Obstetrical brachial plexus palsy, one of the most complex peripheral nerve injuries, presents as an injury during the neonatal period. The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla armpit, and gives rise to nerves to the upper limb arm. Article information, pdf download for prospective study of recovery. In a prospective cohort assessing 94 children with brachial plexus palsy, the authors found abnormalities on crosssectional imaging in 38% of the cases, and 26 62% of the 42 patients who underwent tomography for surgical planning presented evidence of. There are references to this condition back to the the old testament, and galens histories. Lipira summary pediatric brachial plexus palsies can present at birth 1 in newborns and from blunt trauma in older children. A detailed examination of brachial plexus and its terminal branches can be performed within a few minutes in case of cooperative patients. Obstetrical brachial palsy obp also known in its various forms as erbs palsy, klumpkes. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.
The nerves signal these parts of the body to move and to feel picture 1. The overall incidence of nbpp, both transient and persistent impairment, is 1. Neonatal brachial plexus injuries introduction pedscases. This is the most common type of brachial plexus injury at birth. Erb, or erbduchenne palsy, is the name given to a typical upper brachial plexus injury involving spinal nerve roots c5 and c6. In addition, the rate of recovery of different proximal muscles was correlated with the eventual function. Damaged nerves can lead to a loss of feeling and movement from the shoulder to the wrist and fingers. Neonatal brachial plexus injury american academy of. The most common cause of brachial plexus injury is stretching, compressing, or tearing of the nerves that may result in scar formation. It is named for one of the doctors who first described this condition, wilhelm erb.
We developed a rat model of upper trunk bpbp and compared our findings to previously reported animal models. Your child will most likely improve as they get older. Otherwise, surgery can put the infant at risk for permanent loss of function. They identified different patterns of palsies observed at birth. Klumpkes paralysis is a variety of partial palsy of the lower roots of the brachial plexus. The first surgical management of obstetric brachial plexus injury obpi was reported in the. Clinically, neonatal brachial plexus palsy nbpp presents in a newborn as a weak or paralyzed upper extremity, with the passive range of motion greater than the active. Brachial plexus palsy is a pathological condition arising as a result of damage to the brachial plexus. This usually results in paralysis of the shoulder and elbow muscles. The brachial plexus is a network of nerve fusions and divisions that originate from cervical and upper thoracic nerve roots and terminate as named nerves that innervate muscles and skin of the shoulder and arm.
Erbs palsy is recognizable by the characteristic waiters tip position of the hand, which is caused. These nerves originate in the fifth, sixth, seventh and eighth cervical c5c8, and first thoracic t1 spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and hand. Both these types of lesions usually involve a specific injury mechanism that results in the excessive stretching of either the upper plexus due to an increase. About brachial plexus birth palsy injury during a difficult birth, the brachial plexus nerves that run between the neck and shoulder can tear or stretch as the baby comes through the birth canal. Minor brachial plexus injuries, known as stingers or burners, are common. Brachial plexus injuries are classically defined as erbs palsy involving c5 and c6 nerve rootsor klumpkes palsy, in which there is damage to the c8 and t1 nerve roots. The extent of involvement and severity of injury is variable. Brachial plexus injury symptoms and causes mayo clinic. Infant range of motion exercises page two brachial plexus injuries the term obstetrical palsy was first used by duchenne in 1872, and the description of upper root injury was described by erb in 1874. Epidemiology of brachial plexus birth palsy childrens. Neonatal brachial plexus palsy occurs at a rate of about 1 live births in our community, patients are currently managed by a combination of pediatricians, neurologists, therapists, neurosurgeons, and orthopaedic surgeons, and often they are referred to neighboring states for further.
Brachial plexus birth injury boston childrens hospital. In a prospective cohort assessing 94 children with brachial plexus palsy, the authors found abnormalities on crosssectional imaging in 38% of the cases, and 26 62% of the 42 patients who underwent tomography for surgical planning presented evidence of posterior subluxation of the humeral head. The first clinical description of neonatal brachial plexus palsy nbpp was reported in the 1760s. Perinatal brachial plexus palsy pbpp is a flaccid paralysis of the. The brachial plexus is the network of nerves that sends signals from your spinal cord to your shoulder, arm and hand.