Obstetrical Brachial Plexopathy

Question 1

What nerve roots are affected in Erb and Klumpke’s palsies?

Answer 1

Erb’s (C5-T6)

Kumpke’s (C8-T1)

Question 2

What factors are a/w an obstetrical palsy?

Answer 2

1) large for gestational age
2) multiparous pregnancy
3) difficult presentation
4) shoulder dystocia
5) forceps delivery
6) breech position
7) prolonged labor

Question 3

What condition develop in 70% of obstetrical palsy patients?

Answer 3

Glenohumeral dysplasia: increased glenoid retroversion, humeral head flattening, posterior humeral head subluxation

Question 4

What findings are a/w poorer outcomes in Erb’s palsy?

Answer 4

1) lack of biceps function by 3 months
2) preganglionic injuries (worst prognosis)
avulsions from the cord, which will not spontaneously
3) Horner’s syndrome (ptosis, miosis, anhydrosis)
4) less than 10% recover spontaneous motor function
5) C5-C7 involvement
6) Klumpke’s Palsy

Question 5

What is the presentation of Erb’s palsy?

Answer 5

adducted, internally rotated shoulder; pronated forearm, extended elbow (“waiter’s tip”) 
C5 deficiency:
axilllary nerve deficiency
   deltoid, teres minor weakness
suprascapular nerve deficiency
   supraspinatus, infraspinatus weakness 
musculocutaneous nerve deficiency
   biceps weakness 
C6 deficiency
radial nerve deficiency
   brachioradialis, supinator weakness

Question 6

What is the key to treatment of obstetrical palsies?

Answer 6

Therapy to maintain PROM until nerve recovers; 90% recover full function

Question 7

When is nerve transfer indicated over nerve grafting?

Answer 7

If it is a pre-ganglionic lesion

Question 8

An infant is born with total brachial plexus palsy and Horner’s syndrome after a difficult vaginal delivery. What is the prognosis for spontaneous recovery of motor function in the involved arm by 3 months?

Answer 8

Less than 10%