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Current Reviews in Musculoskeletal Medicine
Erschienen in: Current Reviews in Musculoskeletal Medicine 4/2016

28.09.2016 | Pediatric Orthopedics (B Heyworth, Section Editor)

The natural history and management of brachial plexus birth palsy

verfasst von: Kristin L. Buterbaugh, Apurva S. Shah

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 4/2016

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Abstract

Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3–6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.
Literatur
1.
Hoeksma AF, ter Steeg AM, Nelissen RG, van Ouwerkerk WJ, Lankhorst GJ, de Jong BA. Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol. 2004;46:76–83.CrossRefPubMed
2.
Chauhan SP, Rose CH, Gherman RB, Magann EF, Holland MW, Morrison JC. Brachial plexus injury: a 23-year experience from a tertiary center. Am J Obstet Gynecol. 2005;192:1795–800. discussion 1800–1792.CrossRefPubMed
3.
Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90:1258–64.CrossRefPubMed
4.
National Vital Statistics Report 2012 Vol. 61, Centers for Disease Control and Prevention (CDC).
5.
Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004;46:138–44.CrossRefPubMed
6.
Waters PM. Obstetric brachial plexus injuries: evaluation and management. J Am Acad Orthop Surg. 1997;5:205–14.CrossRefPubMed
7.
van Ouwerkerk WJ, van der Sluijs JA, Nollet F, Barkhof F, Slooff AC. Management of obstetric brachial plexus lesions: state of the art and future developments. Childs Nerv Syst. 2000;16:638–44.CrossRefPubMed
8.
Sibiński M, Synder M. Obstetric brachial plexus palsy—risk factors and predictors. Ortop Traumatol Rehabil. 2007;9:569–76.PubMed
9.
Abid A. Brachial plexus birth palsy: management during the first year of life. Orthop Traumatol Surg Res. 2016.
10.
Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74:491–516.CrossRefPubMed
11.
Laurent JP, Lee R, Shenaq S, Parke JT, Solis IS, Kowalik L. Neurosurgical correction of upper brachial plexus birth injuries. J Neurosurg. 1993;79:197–203.CrossRefPubMed
12.
Greenwald AG, Schute PC, Shiveley JL. Brachial plexus birth palsy: a 10-year report on the incidence and prognosis. J Pediatr Orthop. 1984;4:689–92.CrossRefPubMed
13.
Narakas AO. Injuries of the brachial plexus and neighboring peripheral nerves in vertebral fractures and other trauma of the cervical spine. Orthopade. 1987;16:81–6.PubMed
14.
Waters PM. Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am. 1999;81:649–59.CrossRefPubMed
15.
Yoshida K, Kawabata H. The prognostic value of concurrent phrenic nerve palsy in newborn babies with neonatal brachial plexus palsy. J Hand Surg [Am]. 2015;40:1166–9.CrossRef
16.
El-Sayed AA. The prognostic value of concurrent Horner syndrome in extended Erb obstetric brachial plexus palsy. J Child Neurol. 2014;29:1356–9.CrossRefPubMed
17.
18.
Oktay F, Cömert D, Gökkaya NK, Ozbudak SD, Uysal H. Bone age in children with obstetrical brachial plexus palsy: effect of peripheral nerve injury on skeletal maturation. J Child Neurol. 2014;29:203–9.CrossRefPubMed
19.
Bae DS, Ferretti M, Waters PM. Upper extremity size differences in brachial plexus birth palsy. Hand (N Y). 2008;3:297–303.CrossRef
20.
Mallet J. Obstetrical paralysis of the brachial plexus. II. Therapeutics. Treatment of sequelae. Priority for the treatment of the shoulder. Method for the expression of results. Rev Chir Orthop Reparatrice Appar Mot. 1972;58 Suppl 1:166–8.
21.•
Iorio ML, Menashe SJ, Iyer RS, et al. Glenohumeral dysplasia following neonatal brachial plexus palsy: presentation and predictive features during infancy. J Hand Surg [Am]. 2015;40:2345–51.e2341. Comprehensive detailed description of the natural history of glenohumeral dysplasia, its effect on functional outcomes and the importance of screening. CrossRef
22.
Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg [Am]. 2010;35:322–31.CrossRef
23.
Pearl ML, Woolwine S, van de Bunt F, Merton G, Burchette R. Geometry of the proximal humeral articular surface in young children: a study to define normal and analyze the dysplasia due to brachial plexus birth palsy. J Shoulder Elb Surg. 2013;22:1274–84.CrossRef
24.
Eismann EA, Little KJ, Laor T, Cornwall R. Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy. J Bone Joint Surg Am. 2015;97:112–8.CrossRefPubMed
25.
Aly A, Bahm J, Schuind F. Percutaneous humeral derotational osteotomy in obstetrical brachial plexus palsy: a new technique. J Hand Surg Eur Vol. 2014;39:549–52.CrossRefPubMed
26.
27.
Soldado F, Fontecha CG, Marotta M, et al. The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model. J Shoulder Elb Surg. 2014;23:1003–9.CrossRef
28.
Crouch DL, Plate JF, Li Z, Saul KR. Computational sensitivity analysis to identify muscles that can mechanically contribute to shoulder deformity following brachial plexus birth palsy. J Hand Surg [Am]. 2014;39:303–11.CrossRef
29.
Crouch DL, Hutchinson ID, Plate JF, et al. Biomechanical basis of shoulder osseous deformity and contracture in a rat model of brachial plexus birth palsy. J Bone Joint Surg Am. 2015;97:1264–71.CrossRefPubMed
30.
Cheng W, Cornwall R, Crouch DL, Li Z, Saul KR. Contributions of muscle imbalance and impaired growth to postural and osseous shoulder deformity following brachial plexus birth palsy: a computational simulation analysis. J Hand Surg [Am]. 2015;40:1170–6.CrossRef
31.
Sheffler LC, Lattanza L, Hagar Y, Bagley A, James MA. The prevalence, rate of progression, and treatment of elbow flexion contracture in children with brachial plexus birth palsy. J Bone Joint Surg Am. 2012;94:403–9.CrossRefPubMedPubMedCentral
32.
Nikolaou S, Peterson E, Kim A, Wylie C, Cornwall R. Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury. J Bone Joint Surg Am. 2011;93:461–70.CrossRefPubMed
33.
Nikolaou S, Liangjun H, Tuttle LJ, et al. Contribution of denervated muscle to contractures after neonatal brachial plexus injury: not just muscle fibrosis. Muscle Nerve. 2014;49:398–404.CrossRefPubMed
34.
Weekley H, Nikolaou S, Hu L, Eismann E, Wylie C, Cornwall R. The effects of denervation, reinnervation, and muscle imbalance on functional muscle length and elbow flexion contracture following neonatal brachial plexus injury. J Orthop Res. 2012;30:1335–42.CrossRefPubMed
35.
Immerman I, Alfonso DT, Ramos LE, et al. Hand function in children with an upper brachial plexus birth injury: results of the nine-hole peg test. Dev Med Child Neurol. 2012;54:166–9.CrossRefPubMed
36.
Greenhill DA, Lukavsky R, Tomlinson-Hansen S, Kozin SH, Zlotolow DA. Relationships between 3 classification systems in brachial plexus birth palsy. J Pediatr Orthop. 2015.
37.
Heise CO, Siqueira MG, Martins RS, Gherpelli JL. Clinical-electromyography correlation in infants with obstetric brachial plexopathy. J Hand Surg [Am]. 2007;32:999–1004.CrossRef
38.
Van Dijk JG, Pondaag W, Buitenhuis SM, Van Zwet EW, Malessy MJ. Needle electromyography at 1 month predicts paralysis of elbow flexion at 3 months in obstetric brachial plexus lesions. Dev Med Child Neurol. 2012;54:753–8.CrossRefPubMed
39.
Tse R, Nixon JN, Iyer RS, Kuhlman-Wood KA, Ishak GE. The diagnostic value of CT myelography, MR myelography, and both in neonatal brachial plexus palsy. AJNR Am J Neuroradiol. 2014;35:1425–32.CrossRefPubMed
40.
Waters PM, Smith GR, Jaramillo D. Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am. 1998;80:668–77.CrossRefPubMed
41.
Somashekar DK, Di Pietro MA, Joseph JR, Yang LJ, Parmar HA. Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy. Pediatr Radiol. 2015.
42.
Abzug JM, Kozin SH. Evaluation and management of brachial plexus birth palsy. Orthop Clin North Am. 2014;45:225–32.CrossRefPubMed
43.
Haerle M, Gilbert A. Management of complete obstetric brachial plexus lesions. J Pediatr Orthop. 2004;24:194–200.CrossRefPubMed
44.
Gilbert A, Tassin JL. Surgical repair of the brachial plexus in obstetric paralysis. Chirurgie. 1984;110:70–5.PubMed
45.
Bain JR, Dematteo C, Gjertsen D, Hollenberg RD. Navigating the gray zone: a guideline for surgical decision making in obstetrical brachial plexus injuries. J Neurosurg Pediatr. 2009;3:173–80.CrossRefPubMed
46.
Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin. 1995;11:563–80. discussion 580–561.PubMed
47.
Chuang DC, Mardini S, Ma HS. Surgical strategy for infant obstetrical brachial plexus palsy: experiences at Chang Gung Memorial Hospital. Plast Reconstr Surg. 2005;116:132–42. discussion 143–134.CrossRefPubMed
48.
Argenta AE, Brooker J, MacIssac Z, et al. Obstetrical brachial plexus palsy: can excision of upper trunk neuroma and nerve grafting improve function in babies with adequate elbow flexion at nine months of age? J Plast Reconstr Aesthet Surg. 2016.
49.
Clarke HM, Al-Qattan MM, Curtis CG, Zuker RM. Obstetrical brachial plexus palsy: results following neurolysis of conducting neuromas-in-continuity. Plast Reconstr Surg. 1996;97:974–82. Discussion 983–974.CrossRefPubMed
50.
Chin KF, Misra VP, Sicuri GM, Fox M, Sinisi M. Intra-operative neurophysiological prediction of upper trunk recovery in obstetric brachial plexus palsy with neuroma in continuity. Bone Joint J. 2013;95-B:699–705.CrossRefPubMed
51.
Lin JC, Schwentker-Colizza A, Curtis CG, Clarke HM. Final results of grafting versus neurolysis in obstetrical brachial plexus palsy. Plast Reconstr Surg. 2009;123:939–48.CrossRefPubMed
52.
El-Gammal TA, El-Sayed A, Kotb MM, et al. Total obstetric brachial plexus palsy: results and strategy of microsurgical reconstruction. Microsurgery. 2010;30:169–78.CrossRefPubMed
53.•
Tse R, Kozin SH, Malessy MJ, Clarke HM. International Federation of Societies for Surgery of the Hand Committee report: the role of nerve transfers in the treatment of neonatal brachial plexus palsy. J Hand Surg [Am]. 2015;40:1246–59. Editorial that elaborates on the current controversy on the role of nerve transfers versus nerve grafting. CrossRef
54.
Terzis JK, Kostas I. Outcomes with suprascapular nerve reconstruction in obstetrical brachial plexus patients. Plast Reconstr Surg. 2008;121:1267–78.CrossRefPubMed
55.
Midha R. Nerve transfers for severe brachial plexus injuries: a review. Neurosurg Focus. 2004;16:E5.CrossRefPubMed
56.
Bertelli JA, Ghizoni MF. Reconstruction of C5 and C6 brachial plexus avulsion injury by multiple nerve transfers: spinal accessory to suprascapular, ulnar fascicles to biceps branch, and triceps long or lateral head branch to axillary nerve. J Hand Surg [Am]. 2004;29:131–9.CrossRef
57.
Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg [Am]. 1994;19:232–7.CrossRef
58.
Tse R, Marcus JR, Curtis CG, Dupuis A, Clarke HM. Suprascapular nerve reconstruction in obstetrical brachial plexus palsy: spinal accessory nerve transfer versus C5 root grafting. Plast Reconstr Surg. 2011;127:2391–6.CrossRefPubMed
59.
Pondaag W, de Boer R, van Wijlen-Hempel MS, Hofstede-Buitenhuis SM, Malessy MJ. External rotation as a result of suprascapular nerve neurotization in obstetric brachial plexus lesions. Neurosurgery. 2005;57:530–7. discussion 530–537.CrossRefPubMed
60.
Siqueira MG, Socolovsky M, Heise CO, Martins RS, Di Masi G. Efficacy and safety of Oberlin’s procedure in the treatment of brachial plexus birth palsy. Neurosurgery. 2012;71:1156–60. Discussion 1161.CrossRefPubMed
61.
Little KJ, Zlotolow DA, Soldado F, Cornwall R, Kozin SH. Early functional recovery of elbow flexion and supination following median and/or ulnar nerve fascicle transfer in upper neonatal brachial plexus palsy. J Bone Joint Surg Am. 2014;96:215–21.CrossRefPubMed
62.
Al-Qattan MM, Al-Kharfy TM. Median nerve to biceps nerve transfer to restore elbow flexion in obstetric brachial plexus palsy. Biomed Res Int. 2014;2014:854084.PubMedPubMedCentral
63.
McRae MC, Borschel GH. Transfer of triceps motor branches of the radial nerve to the axillary nerve with or without other nerve transfers provides antigravity shoulder abduction in pediatric brachial plexus injury. Hand (N Y). 2012;7:186–90.CrossRef
64.
El-Gammal TA, Abdel-Latif MM, Kotb MM, et al. Intercostal nerve transfer in infants with obstetric brachial plexus palsy. Microsurgery. 2008;28:499–504.CrossRefPubMed
65.
Gu YD. Contralateral C7 root transfer over the last 20 years in China. Chin Med J. 2007;120:1123–6.PubMed
66.
Carlstedt T, Grane P, Hallin RG, Norén G. Return of function after spinal cord implantation of avulsed spinal nerve roots. Lancet. 1995;346:1323–5.CrossRefPubMed
67.
Amr SM, Essam AM, Abdel-Meguid AM, Kholeif AM, Moharram AN, El-Sadek RE. Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy. J Brachial Plex Peripher Nerve Inj. 2009;4:8.PubMedPubMedCentral
68.
Seruya M, Shen SH, Fuzzard S, Coombs CJ, McCombe DB, Johnstone BR. Spinal accessory nerve transfer outperforms cervical root grafting for suprascapular nerve reconstruction in neonatal brachial plexus palsy. Plast Reconstr Surg. 2015;135:1431–8.CrossRefPubMed
69.
Louden EJ, Broering CA, Mehlman CT, Lippert WC, Pratt J, King EC. Meta-analysis of function after secondary shoulder surgery in neonatal brachial plexus palsy. J Pediatr Orthop. 2013;33:656–63.CrossRefPubMed
70.
Kruit AS, Choukairi F, Mishra A, Gaffey A, Jester A. Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study. Int Orthop. 2015.
71.
Noaman HH. Anterior shoulder release and tendon transfer as 1-stage procedure for treatment of internal rotation contracture deformity in obstetric brachial plexus injuries. Ann Plast Surg. 2013;71:510–8.CrossRefPubMed
72.
Waters PM, Bae DS. The early effects of tendon transfers and open capsulorrhaphy on glenohumeral deformity in brachial plexus birth palsy. Surgical technique. J Bone Joint Surg Am. 2009;91(2):213–22.CrossRefPubMed
73.
Bae DS, Waters PM. External rotation humeral osteotomy for brachial plexus birth palsy. Tech Hand Up Extrem Surg. 2007;11:8–14.CrossRefPubMed
74.
Gilbert A, Valbuena S, Posso C. Obstetrical brachial plexus injuries: late functional results of the Steindler procedure. J Hand Surg Eur Vol. 2014;39:868–75.CrossRefPubMed
75.
Ezaki M, Malungpaishrope K, Harrison RJ, et al. OnabotulinumtoxinA injection as an adjunct in the treatment of posterior shoulder subluxation in neonatal brachial plexus palsy. J Bone Joint Surg Am. 2010;92:2171–7.CrossRefPubMed
76.•
Greenhill DA, Wissinger K, Trionfo A, Solarz M, Kozin SH, Zlotolow DA. External rotation predicts outcomes after closed glenohumeral joint reduction with botulinum toxin type A in brachial plexus birth palsy. J Pediatr Orthop. 2016. Describes the current use and limitations of botulinum toxin for glenohumeral dysplasia and internal rotation contracture. Highlights the use of botulinum toxin as an adjunct to closed reduction of the glenohumeral joint in order to optimize development.
77.
Price AE, Ditaranto P, Yaylali I, Tidwell MA, Grossman JA. Botulinum toxin type A as an adjunct to the surgical treatment of the medial rotation deformity of the shoulder in birth injuries of the brachial plexus. J Bone Joint Surg (Br). 2007;89:327–9.CrossRef
78.
Arad E, Stephens D, Curtis CG, Clarke HM. Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy. Plast Reconstr Surg. 2013;131:1307–15.CrossRefPubMed
79.
Zuckerman SL, Allen LA, Broome C, et al. Functional outcomes of infants with Narakas grade 1 birth-related brachial plexus palsy undergoing neurotization compared with infants who did not require surgery. Childs Nerv Syst. 2016.
80.
Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995;11:583–94. Discussion 594–585.PubMed
81.
Hentz VR, Meyer RD. Brachial plexus microsurgery in children. Microsurgery. 1991;12:175–85.CrossRefPubMed
82.
Bae DS, Zurakowski D, Avallone N, Yu R, Waters PM. Sports participation in selected children with brachial plexus birth palsy. J Pediatr Orthop. 2009;29:496–503.CrossRefPubMed
83.
Squitieri L, Larson BP, Chang KW, Yang LJ, Chung KC. Understanding quality of life and patient expectations among adolescents with neonatal brachial plexus palsy: a qualitative and quantitative pilot study. J Hand Surg [Am]. 2013;38:2387–97.e2382.CrossRef
Metadaten
Titel
The natural history and management of brachial plexus birth palsy
verfasst von
Kristin L. Buterbaugh
Apurva S. Shah
Publikationsdatum
28.09.2016
Verlag
Springer US
Erschienen in
Current Reviews in Musculoskeletal Medicine / Ausgabe 4/2016
Elektronische ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-016-9374-3

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