Brachial Plexus Birth Palsy-The natural history and management of brachial plexus birth palsy

The natural history and management of brachial plexus birth palsy

Pdf Summary

Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs during childbirth due to an injury to the brachial plexus. Approximately 20% of children with BPBP will have residual neurological deficits, resulting in permanent alteration of upper limb function. The diagnosis of BPBP is typically made at birth based on the lack of spontaneous movement in the affected limb and can be confirmed through physical examination. Microsurgery and secondary procedures can be effective in improving functional outcomes in patients with BPBP. Microsurgery is recommended for infants who do not demonstrate sufficient spontaneous neurologic recovery, while secondary procedures are typically performed in toddlers or children with persistent functional deficits. Some of the secondary procedures include joint capsule release, tendon lengthening or transfers, and humeral derotational osteotomy. The natural history of BPBP varies from patient to patient, with 66-92% of infants experiencing spontaneous recovery of elbow flexion against gravity within the first 2 months of life. However, 10-30% of patients will be left with permanent weakness or altered function in the affected limb. It is important to note that timing of surgery and the selection of the appropriate surgical procedure are still topics of debate in the field. Future research on topics such as timing of surgery and the use of botulinum toxin as an adjunct to treatment may provide further insights into optimizing management of BPBP. Overall, early intervention and proper management can substantially improve the functional outcomes of children with BPBP.

Keywords

Brachial plexus birth palsy

upper extremity paralysis

neurological deficits

permanent alteration

microsurgery

secondary procedures

functional outcomes

spontaneous recovery

timing of surgery

botulinum toxin