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    Obstetric Brachial Plexus Injuries (Birth Palsy/Erb’s Palsy)

    Obstetric Brachial Plexus Injuries (Birth Palsy/Erb’s Palsy)

    What is Brachial Plexus?

    The upper limb is supplied by a group of nerves coming from the spinal cord at the level of the neck, and conducts signals from the spinal cord, to shoulder, arm and hand. This group of nerves is called Brachial plexus. These nerves originate from cervical (C5-C8), and first thoracic (T1) spinal nerves, and give nerve supply to the muscles and skin of the chest, shoulder, arm and hand.

    What is Obstetric Brachial Plexus injury?

    Obstetric injuries may occur from mechanical injury during difficult childbirth in which the nerves of the plexus are violently stretched. It may be due to forceps/ Vacuum assisted delivery, shoulder dystocia , but occasionally Caesarean section cases it presents.

    What is Erb’s palsy?

     When upper roots of brachial plexus get injured leading to paralysis of group of muscle of shoulder and arm.”The position of the limb, under such conditions, is characteristic: the arm hangs by the side and is rotated toward body; the forearm is straight and palm facing backward. The arm cannot be raised from the side; all power of bending of the elbow is lost, as is also palm facing front of the forearm”

    How to diagnose brachial plexus injury?

    It is based on thorough clinical evaluation and special investigations to know the exact level of the injury. There are Electrophysiological test e.g. EMG and NCV help in diagnosis. CT myelography or MRI of cervical spine to be done to see spinal nerve roots changes which help in support of diagnosis.

    How to manage OBPI?

    After initial evaluation and establishment of diagnosis, parents are advised for range of movement exercises to prevent muscle tightness, sometimes galvanic stimulation to prevent further muscle weakness. They are advised to come to monthly follow up to see improvement of function.

    When to proceed for surgery?

    On follow up examination, if there is no significant improvement, there are indications of surgery to restore function by early intervention.

    What should be done if child presents with late deformities of Brachial Plexus injury?

    There are various procedures to correct secondary deformities e.g. release of tight muscle, muscle transfers or tendon transfers or bony procedures etc.

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