Neonatal Brachial Plexus Palsy: a review.

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Neonatal Brachial Plexus Palsy (NBPP) has an incidence rate of 0.5–2 cases per 1000 newborns in developed countries. (2) Neonatal macrosomia, shoulder dystocia, and breach birth are common causes of NBPP.

Differential diagnosis includes clavicular fracture, osteomyelitis, and septic arthritis. (3) These conditions may produce pseudoparalysis which can mimic brachial plexus injury.

Cervical ribs may predispose to Erb’s palsy by the stretching of nerves around the cervical rib or through concentrated pressure when the shoulder is forced against the cervical spine. (3)

Fortunately, the rate of complete recovery is 80% to 96%, especially if improvement begins in the first two weeks. (3) NBPP is also decreasing in frequency due to improvements in obstetric care.

Injury to the upper trunk (C5/6) is termed Erb’s Palsy and injury to the lower trunk C8/T1 is termed Klumpke’s Palsy. Erb’s palsy impairs abduction and ER of the shoulder while sparing hand function, whereas Klumpke’s Palsy impairs hand function.

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Conservative treatment includes rehabilitation with a team of therapists. It may include immobilization, hydrotherapy, botulinum injections to prevent muscle imbalance, and/or electrostimulation to aid in functional muscle recovery.

Hydrotherapy is a form of physical therapy used because of the anti-gravity environment. It minimizes the stress on the musculoskeletal frame, allowing the neonate to move with less pain and at the same time strengthening muscles and reducing spasms. (1)

"It is unanimous that conservative treatment is always started as early as possible." (2) During conservative therapy "sensory stimulation is as important as motor stimulation and can consist in suckling any finger on the injured limb". (2)

Surgical treatment is a last resort and reserved for patients that do not respond to conservative therapy, surgical options will not be covered in this review.

About 90% of infants with Erb’s palsy will show recovery with time, but 10% will continue to have a dysfunctional arm. (1) Early initiation of conservative treatment can improve the quality of life and function of the limb for patients with NNBP.


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Ortho Reviews - Neonatal Brachial Plexus Injury