Team Approach: Management of Brachial Plexus Birth Injury
Sandra Schmieg1, Jie C Nguyen1, Meagan Pehnke1
1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Brachial plexus birth injury causes upper-extremity paralysis in infants. Early intervention with a multidisciplinary team and occupational therapy optimizes functional recovery and addresses potential long-term complications.
Area of Science:
- Pediatric neurology
- Orthopedic surgery
- Rehabilitation medicine
Background:
- Brachial plexus birth injury (BPBI) results from traction injury during birth, leading to upper-extremity paralysis.
- 10-30% of affected children experience residual neurologic deficits impacting upper-limb function.
Observation:
- A multidisciplinary team approach optimizes functional recovery in BPBI.
- Early occupational therapy focusing on range of motion and motor learning is crucial.
- Predictors for microsurgical reconstruction are identified through early physical examination.
Findings:
- Microsurgical reconstruction is typically performed between 3 to 9 months of age.
- Residual deficits often lead to glenohumeral dysplasia.
- Secondary procedures like botulinum toxin injections and surgical lengthening may be required.
Implications:
- Timely and appropriate management can significantly improve outcomes for children with BPBI.
- Addressing glenohumeral dysplasia is essential for long-term upper-limb function.
- Multidisciplinary care ensures comprehensive treatment, from initial injury to secondary complications.
Abstract:
Brachial plexus birth injury is an upper-extremity paralysis that occurs from a traction injury to the brachial plexus during birth. Approximately 10% to 30% of children with a brachial plexus birth injury have residual neurologic deficits with associated impact on upper-limb function. Management of brachial plexus birth injuries with a multidisciplinary team allows optimization of functional recovery while avoiding unnecessary intervention. Early occupational therapy should be initiated with a focus on range of motion and motor learning. The need for microsurgical reconstruction of the brachial plexus can be predicted based on early physical examination findings, and reconstruction is generally performed at 3 to 9 months of age. The majority of children with residual neurologic deficits develop associated glenohumeral dysplasia. These children may require secondary procedures, including botulinum toxin injection, subscapularis and pectoralis lengthening, shoulder capsular release, shoulder tendon transfer, and humeral osteotomy.
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