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[Neurophysiological assessment of children with obstetric brachial plexus palsy]
O Papazian1, I Alfonso, J A Grossman
1Brachial Plexus Palsy Center, Miami Children's Hospital, Florida 33155, USA.
Insights
Neurophysiological evaluation using electromyography (EMG) and nerve conduction studies helps diagnose brachial plexus palsy in infants. These tests determine lesion timing, location, and guide surgical interventions for optimal outcomes.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Musculoskeletal Disorders
Context:
- Brachial plexus palsy significantly impacts infant upper extremity function.
- Accurate diagnosis is crucial for timely and effective management.
- Understanding lesion characteristics guides treatment strategies.
Purpose:
- To outline the neurophysiological evaluation objectives for infants with brachial plexus palsy.
- To detail the methods used for lesion assessment: needle electromyography (EMG) and nerve conduction studies.
- To establish the timing and indications for these diagnostic tests.
Summary:
- Needle EMG and nerve conduction studies are employed to assess affected muscles and nerves.
- EMG in the first week of life determines lesion age for medico-legal purposes and pre-surgical assessment.
- Studies at 3 and 6 months identify candidates for surgical exploration; intraoperative studies guide surgical procedures.
Impact:
- Provides a framework for diagnosing brachial plexus palsy in infants.
- Facilitates medico-legal assessments and pre-surgical evaluations.
- Guides surgical decision-making for improved functional recovery in affected infants.
Introduction:
The objectives of the neurophysiological evaluation of infants with brachial plexus palsy are to determine the time of occurrence of the lesion, to locate the lesion and to determine its course.
Methods And Conclusions:
These objectives are achieved by studying affected upper extremity muscles by needle electromiography (EMG) and affected nerves by motor and sensory conduction studies. EMG is performed in the first week of life in those patients with brachial plexus palsy of unknown etiology to determine the age of the lesion for medico-legal reasons. EMG is performed before surgery for tendon transfer in the selected muscles to assure that they are normal. EMG and motor and sensory conduction studies are performed at the age of 3 and 6 months in infants with less than 4 muscle weakness to determine candidates for surgical exploration. Motor and sensory nerve conduction studies are performed intraoperative to determine the functional status of the affected axons and the best surgical procedure (neurotization, neurolysis and/or neuroma resection and homologous nerve graft).