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The natural history and management of brachial plexus birth palsy

Kristin L Buterbaugh1, Apurva S Shah2

  • 1Division of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Wood Building Room 2307, Philadelphia, PA, 19104-4318, USA.

Current Reviews in Musculoskeletal Medicine
|September 30, 2016
PubMed

Insights

Brachial plexus birth palsy (BPBP) can cause upper extremity paralysis. Early identification of elbow flexion recovery guides microsurgical intervention for improved limb function.

Area of Science:

  • Pediatric Orthopedics
  • Pediatric Neurology

Background:

  • Brachial plexus birth palsy (BPBP) results from brachial plexus traction injury during childbirth, leading to upper extremity paralysis.
  • About 20% of affected children experience residual neurologic deficits, impacting long-term upper limb function.
  • The variable natural history of BPBP necessitates optimized management strategies.

Approach:

  • Diagnosis of BPBP is primarily clinical, without routine reliance on cross-sectional imaging.
  • Physical examination is crucial for identifying candidates requiring microsurgical reconstruction.
  • Recovery of antigravity elbow flexion by 3-6 months of age is a key indicator for surgical intervention.

Key Points:

  • Microsurgical reconstruction, including nerve transfers and grafting, is effective for infants with BPBP.
  • Secondary procedures like botulinum toxin injections, tendon transfers, and osteotomies can improve outcomes in older children.
  • Both primary microsurgery and secondary procedures offer substantial functional improvements.

Conclusions:

  • Early and accurate diagnosis of BPBP is essential for timely intervention.
  • Physical examination findings, particularly antigravity elbow flexion, guide treatment decisions.
  • A combination of microsurgical and secondary procedures can significantly enhance functional outcomes for children with BPBP.

Keywords:
Birth palsyBrachial plexusErb’s palsyGlenohumeral dysplasiaMicrosurgeryTendon transfers

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