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Entrapment neuropathy contributing to dysfunction after birth brachial plexus injuries
P David Adelson1, N Ake Nystrom, Robert Sclabassi
1Brachial Plexus and Peripheral Nerve Injury Center, Children's Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. david.adelson@chp.edu
Journal of Pediatric Orthopedics
|October 4, 2005
Summary
Persistent shoulder weakness in brachial plexus birth palsy may stem from axillary nerve compression. Surgical intervention can improve shoulder abduction and elevation in affected children.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Surgical Innovation
Background:
- Brachial plexus birth palsy (BPBP) often results in persistent deltoid muscle weakness, impacting shoulder abduction and elevation.
- The exact etiology of this weakness, even with good arm and hand function, remains incompletely understood and potentially multifactorial.
- Clinical findings suggest factors beyond primary nerve injury may contribute to deltoid dysfunction.
Observation:
- A retrospective study examined 10 children (9 months to 8 years) with BPBP, limited shoulder external rotation, and impaired arm elevation.
- These children exhibited position-dependent weakness, hinting at secondary nerve impingement.
- Surgical treatment focused on augmenting shoulder function in these specific cases.
Findings:
- All 10 children demonstrated increased shoulder range of motion post-surgery.
- Eight out of ten children showed significant improvement in shoulder abduction and elevation.
- Intraoperative electrophysiologic monitoring and functional testing supported the findings.
Implications:
- Secondary compression of the axillary nerve within the quadrangular space is identified as a common cause of deltoid weakness in BPBP.
- This finding suggests a distinct pathological entity contributing to persistent shoulder dysfunction.
- Early surgical intervention targeting axillary nerve decompression may be crucial for improving outcomes in affected children.