Shoulder sequelae of neonatal brachial plexus injuries: orthopedic assessment and management

Area of Science:

• Pediatric Orthopedics
• Neonatal Care
• Neurology

Background:

• Brachial plexus birth palsy affects 1-4/1000 live births, often resulting in permanent neurologic deficits.
• Muscle imbalance from brachial plexus birth palsy leads to shoulder pathology, including soft tissue contractures and glenohumeral joint changes.
• Internal rotation contractures are common, causing significant disability in affected children.

Purpose of the Study:

• To review the orthopedic evaluation and management of neonatal brachial plexus palsy (NBPP).
• To emphasize the importance of early recognition and prompt referral for NBPP.
• To guide clinicians in managing shoulder sequelae associated with NBPP.

Main Methods:

• Review of existing literature on neonatal brachial plexus palsy and its orthopedic management.
• Analysis of clinical presentation, diagnostic methods, and treatment strategies.
• Emphasis on physical examination, imaging, and family-centered goal assessment.

Main Results:

• Spontaneous recovery occurs in most cases, but some infants develop permanent neurologic deficits.
• Shoulder pathology, including contractures and joint changes, can progress and limit function.
• Surgical intervention is considered for functionally limiting contractures, joint changes, or instability.

Conclusions:

• Early recognition and appropriate management of shoulder sequelae in NBPP are essential.
• A comprehensive approach involving physical examination, imaging, and family expectations is critical.
• Prompt referral and orthopedic intervention can improve shoulder function and prevent long-term disability.