Brachial Plexus Birth Palsy-FSSH Scientific Committee on Neonatal Brachial Plexus Palsy

FSSH Scientific Committee on Neonatal Brachial Plexus Palsy

Pdf Summary

The role of nerve transfers in the treatment of neonatal brachial plexus palsy is still uncertain. Nerve transfers have been successful in adult cases, but their effectiveness for neonatal cases is unclear. The current literature does not provide enough evidence to determine whether nerve transfers should be the primary strategy for nerve reconstruction in Erb palsy. In cases of severe palsies, the existing nerve transfers are inadequate in addressing all target muscles. The primary goal should be maximizing re-innervation in order to improve limb function, growth, and the potential for secondary musculoskeletal reconstruction. Future studies should use a standardized outcome measure and clearly define how outcomes are assessed. Neonatal brachial plexus palsy occurs in about 1 in 1000 newborn infants, with 10-30% of infants benefiting from surgery. Nerve transfers involve using functioning donor nerves to innervate non-functioning distal targets. They can be done using intraplexus donors (within the affected brachial plexus) or extraplexus donors (outside of the affected brachial plexus). Commonly described nerve transfers for neonatal brachial plexus palsy include median and/or ulnar to biceps and/or brachialis, radial triceps branch to axillary anterior deltoid branch, spinal accessory to suprascapular nerve, and intracostals to musculocutaneous. The available literature on the outcomes of nerve grafting and nerve transfer for NBPP is limited and lacks direct comparisons between the two.

Keywords

nerve transfers

neonatal brachial plexus palsy

uncertain

nerve reconstruction

severe palsies

limb function

surgery

intraplexus donors

extraplexus donors

nerve grafting