Brachial Plexus Birth Palsy-Case: Brachial Plexus Palsy

Case: Brachial Plexus Palsy

Pdf Summary

This case involves a 3-month-old female who experienced a flaccid left upper extremity and was diagnosed with birth brachial plexus palsy following a complicated delivery. The patient has no active biceps, deltoid, wrist extension, or hand function and shows a positive Horner's sign. Sensation is present to the C5, C6, and C7 distribution but not to the C8 and T1 distribution.<br /><br />The considerations for treatment in this case include determining if surgery is indicated at this time or if continued observation should be pursued. The possible approaches to surgery include exploration and nerve grafting, neurolysis of neuroma, or nerve transfers.<br /><br />In terms of operative findings, it is essential to prioritize the reconstruction of hand function. The best nerve roots should be grafted to the lower trunk, and shoulder and elbow reconstruction can be achieved through tendon transfers.<br /><br />The take-home points from this case are as follows:<br />- If hand function does not recover, surgery is indicated at 3 months of age.<br />- The primary focus of reconstruction should be on achieving hand function.<br />- The best nerve roots should be grafted to the lower trunk, and tendon transfers can be used for shoulder and elbow reconstruction.<br /><br />However, if hand function remains intact, surgery can be delayed until 6 months of age to monitor recovery. In cases of partial upper/middle trunk recovery, nerve grafting or nerve transfers can be utilized to restore function.<br /><br />Overall, this case highlights the importance of early intervention and prioritization of hand function in the treatment of birth brachial plexus palsy. The specific surgical approach should be tailored to the individual patient's needs and recovery progress.

Keywords

birth brachial plexus palsy

complicated delivery

flaccid left upper extremity

Horner's sign

surgery

nerve grafting

neurolysis of neuroma

nerve transfers

reconstruction of hand function

tendon transfers