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The cervical rib. A predisposing factor for obstetric brachial plexus lesions
M H J Becker1, F Lassner, J Bahm
1Clinic for Plastic and Hand Surgery, University of Witten-Herdecke, Klinikum Wuppertal, Germany.
The Journal of Bone and Joint Surgery. British Volume
|August 22, 2002
Summary
Obstetric brachial plexus injuries may result from anatomical variations like cervical ribs, not just birth trauma. These variations can narrow spaces, making nerves vulnerable to injury during delivery.
Area of Science:
- Obstetrics
- Pediatric Neurology
- Anatomy
Background:
- The cause of obstetric brachial plexus injuries (OBPI) is debated, with traction during delivery being the commonly accepted etiology.
- However, OBPI cases without significant traction history and those from Cesarean sections challenge this view.
Purpose of the Study:
- To investigate potential contributing factors to OBPI beyond birth trauma.
- To explore the role of anatomical variations in the development of OBPI.
Main Methods:
- Retrospective case series analysis of 42 infants with OBPI.
- Clinical assessment of injury type (Erb's palsy vs. extensive lesions).
- Radiographic evaluation for anatomical abnormalities such as cervical ribs.
Main Results:
- Of 42 infants, 28 had Erb's palsy, and 14 had more extensive brachial plexus lesions.
- Five infants with extensive lesions were found to have complete ossified cervical ribs.
- These findings suggest a link between anatomical variations and OBPI severity.
Conclusions:
- Anatomical variations, specifically ossified cervical ribs and fibrous bands, may predispose infants to OBPI.
- These variations can cause narrowing of the supraclavicular space, increasing nerve susceptibility to injury.
- This challenges the sole reliance on birth trauma as the cause of OBPI.