Perinatal Brachial Plexus Injury Flashcards
What is the incidence of brachial plexus injury?
0.4 - 5 per 1000
How do brachial plexus injuries present?
Flaccid paralysis
How do brachial plexus injuries occur?
Birth trauma
Trauma before birth
What percentage of brachial plexus injuries resolve?
70 - 80%
What percentage of brachial plexus injuries do not resolve?
20 - 30%
Which babies are at risk for brachial plexus injuries?
LGA
IDM
Shoulder dystocia
Instrumental delivery
What is the best way to treat brachial plexus injuries?
Unclear.
No RCT re primary surgical exploration versus conservative management
Non RCT evidence shows that maybe those with severe injuries may do better with surgery
What do you tell families?
- likely unpreventable
- 75% recover within the first month
- 25% do no recover and likely have permanent disability
What do you do with the patient?
Follow for 1 month and reexamine at 1 month. If no improvement refer to the MDT for brachial plexus injuries
How do the specialists decide what to do?
History, exam, EMG and imaging
Does secondary soft tissue and bone reconstructive surgery help?
May improve function but is inferior to primary intervention
What nerve roots are injured?
C5 - T1
