Management of Obstetrical Brachial Plexus Palsy: The Stanford Experience

ABSTRACT

Stanford's experience in the management of obstetrical brachial plexus palsy dates from 1983. A formal clinic service began in 1992. The tenets of management include early evaluations, a dependence on sequential evolution for decision making, and very early neural surgery for babies with abnormal hands. We watch babies with normal hands for a longer time before advising surgery. Intraoperative evoked potentials are used to make surgical decisions. Reconstructive goals for upper plexus injuries include shoulder and elbow control. The paramount goal for babies with global palsies is hand function. Therapy throughout the child's growth years is vital. Sequelae, particularly shoulder contractures, require early surgical intervention. Secondary reconstructive procedures are typically beneficial in improving function. Since 1992, more than 400 children have been examined; 62 have had neural reconstruction and 102 have undergone secondary procedures. Surgery has been remarkably complication free. All children having neural reconstruction except two have benefited.

Obstetrical brachial plexus palsy - reconstructive surgery - secondary procedures - intraoperative evoked potentials

REFERENCES

• 1 Tassin J. Paralysies obstétricales du plexus brachial: Evolution spontanée, résultats des interventions réparatrices process. Paris; Université Paris VII 1983
• 2 Gilbert A, Khouri N, Carlioz H. Birth palsy of the brachial plexus-surgical exploration and attempted repair in twenty one cases (author's transl) [in French].  Rev Chir Orthop Reparatrice Appar Mot. 1980;  66 33-42
• 3 Gilbert A, Tassin J. Réparation chirurgicale du plexus brachial dan a paralysis obstétricale.  Chirurgie. 1984;  110 70-75
• 4 Loy S, Bhatia A, Asfazadourian H, Oberlin C. Ulnar nerve fascicle transfer onto to the biceps muscle nerve in C5-C6 or C5-C6-7 avulsions of the brachial plexus. Eighteen cases.  Ann Chir Main Memb Super. 1997;  16 275-284
• 5 Pearl M L, Edgerton B W. Glenoid deformity secondary to brachial plexus birth palsy.  J Bone Joint Surg Am. 1998;  80 659-667
• 6 Rollnik J D, Hierner R, Schubert M et al.. Botulinum toxin treatment of cocontractions after birth-related brachial plexus lesions.  Neurology. 2000;  55 112-114
• 7 Zancolli E A, Zancolli Jr E R. Palliative surgical procedures in sequelae of obstetrical palsy.  Hand Clin. 1988;  4 643-669
• 8 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 [in French].  Rev Chir Orthop Reparatrice Appar Mot. 1972;  58(suppl 1) 166-168