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Self-mutilation in children with obstetric brachial plexus palsy
1Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia.
Insights
Self-mutilation occurs in 4.7% of obstetric brachial plexus injury cases, particularly in total palsy. Affected children bite digits or hands, a behavior possibly linked to denervation.
Area of Science:
- Neurology
- Pediatrics
- Orthopedics
Background:
- Obstetric brachial plexus injury (OBPI) can lead to significant functional deficits.
- Self-mutilation is a rare but concerning complication in children with neurological impairments.
Purpose of the Study:
- To determine the incidence and clinical characteristics of self-mutilation in infants with OBPI.
- To compare self-mutilation patterns between total palsy and Erb's palsy.
Main Methods:
- Prospective documentation of 127 consecutive cases of OBPI.
- Clinical assessment of self-mutilation, including location and severity.
- Analysis of the relationship between palsy type and self-mutilation.
Main Results:
- Self-mutilation was observed in 4.7% (6/127) of OBPI cases.
- Incidence was higher in total palsy (4/37) than Erb's palsy (2/90).
- Total palsy cases showed severe digital biting; Erb's palsy cases had mild dorsal hand mutilation.
Conclusions:
- Self-mutilation is a recognized complication of OBPI, with varying severity based on palsy type.
- The ability to self-mutilate suggests preserved or compensatory motor function.
- Further research into the mechanisms of self-mutilation in OBPI is warranted.
Abstract:
In a prospective study, the incidence and clinical presentation of self-mutilation was documented in 127 consecutive cases of obstetric brachial plexus injury. Six out of the 127 cases (4.7%) had clinical evidence of self-mutilation. The incidence of self-mutilation was much higher among children with total palsy (4/37) than Erb's palsy (2/90). All affected children were able to bring the mutilated hand or forearm to the mouth without assistance from the contralateral normal limb. Mutilation in patients with total palsy was generally severe and usually involved biting the tips of the digits. However, mutilation in patients with upper (Erb's) palsy was mild in degree and tended to involve the dorsum of the hand. Similarity between human self-mutilation and animal autotomy following denervation are discussed along with the different theories explaining the mechanism of this abnormal behaviour.