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Long-term follow-up of children with obstetric brachial plexus palsy I: functional aspects
Christina Strömbeck1, Lena Krumlinde-Sundholm, Sten Remahl
1Department of Neuropaediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. christina.strombeck@karolinska.se
Insights
Ongoing follow-up is crucial for children with obstetric brachial plexus palsy (OBPP). While shoulder and hand function often remain stable or improve, elbow function may decline, necessitating continued monitoring beyond early childhood.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Obstetric brachial plexus palsy (OBPP) can lead to long-term functional deficits.
- Understanding the natural history and developmental trajectory of OBPP sequelae is essential for optimal patient management.
- Previous studies often focus on early childhood outcomes, leaving long-term functional changes less understood.
Purpose of the Study:
- To describe the development of sequelae in obstetric brachial plexus palsy (OBPP).
- To identify differences in functional outcomes between age 5 and long-term follow-up (2-15 years later).
- To evaluate the impact of interventions like shoulder surgery on functional outcomes.
Main Methods:
- Longitudinal cohort study of 70 participants (aged 7-20 years) with varying degrees of OBPP severity.
- Assessment of active joint motion, shoulder function, and hand function (including grip strength) at baseline (age 5) and long-term follow-up.
- Comparison of functional status between the two time points and analysis of outcomes based on surgical intervention.
Main Results:
- Active shoulder and hand function, particularly grip strength, generally remained stable or improved over time.
- A slight but significant deterioration in elbow function was observed in the cohort.
- Shoulder surgery led to considerable improvements in shoulder function; nerve reconstruction showed similar change profiles to non-operated participants.
Conclusions:
- Ongoing follow-up of children with OBPP beyond preschool years is necessary due to potential declines in elbow function.
- Common long-term issues include restricted external shoulder rotation and individual variations in functional outcomes.
- This study highlights the need for continued monitoring to manage evolving functional deficits in OBPP.
Abstract:
The aims of this study were to describe the development of sequelae in obstetric brachial plexus palsy (OBPP) and to identify possible differences in functional outcome from 5 years of age to follow-up, 2 to 15 years later. A cohort of 70 participants (35 males, 35 females; age range 7-20y, mean 13y 6mo [SD 4y 3mo], median 13y) with OBPP of varying degrees of severity were monitored. Differences in status between 5 years of age and follow-up were studied. Active joint motion in the shoulder and hand function, especially grip strength, generally remained unchanged or improved, whereas a slight but significant deterioration occurred in elbow function. Shoulder surgery resulted in considerable improvement of shoulder function. Participants with nerve reconstruction had a similar profile of change as the non-operated group. It was concluded that ongoing follow-up of children with OBPP, beyond the preschool years, is required due to decreases in elbow function, a commonly occurring restriction in external rotation of the shoulder, together with individual variations in long-term outcomes. In a related article (part II: neurophysiological aspects) long-term neurophysiological and sensory aspects of OBPP are reported.
