The brachial plexus is a network of nerves connecting the spine at the base of the neck to the shoulders and upper extremities. Brachial plexus birth palsy (BPBP) is upper-limb paralysis in a newborn owing to injury to one or more nerve roots of the brachial plexus. The most prevalent form is Erb’s palsy, whereby movements around the shoulder and flexion at the elbow are impaired due to injury to C5-C6 nerve roots. Total BPBP occurs when nerve roots from C5-T1 are injured, thereby impairing all movement and sensation in shoulders, arms, elbow, wrist, and fingers. In most cases, injuries are transient and recover spontaneously within 1 month to 2 years; however, ~27-35% of BPBP cases may develop permanent upper-extremity paralysis. Prognosis depends on the severity and location of the injury.
Pathophysiology
Related Anatomy
Exam Findings, Signs and Positive Tests
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Incidence and Related Conditions
Differential Diagnosis
Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208
A typical patient is an infant, with birth weight above 4 Kg, delivered using a vacuum or forceps after a prolonged labor associated with shoulder dyscotia. In some cases, clavicular fracture may have occurred. Movements of the affected upper limb are impaired, whereas the other limb shows active movement. Most often, muscles around the shoulder and the elbow are paralyzed, with fingers and wrist showing active movements. In some cases, all movements and sensory functions are absent in the affected upper limb.
Non-operative
Microsurgery is indicated in patients who do not gain anti-gravity elbow function by 3 months
Delayed secondary procedures
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