Brachial Plexus Birth Palsy is a nerve injury to the brachial plexus( a group of nerves that originate from the spinal cord, traverses the neck and supplies the arm) around the time of birth due to stretching or avulsion. It mostly involves upper trunks and is thus also known as Erb’s palsy.

Description : The prognosis dependes on the amount of stretch on the nerves. In majority of cases it is neurapraxia and all movements recover by 6weeks. However in cases of axontmesis, it may take 6months and recover partially. Root avulsion is the most severe type of injury which requires neural reconstruction. Patients presenting late (residual BPBP) may be benefitted by muscle rebalancing surgeries.

Diagnosis : It is usually made by the paediatrician on clinical examination. Decreased use of the affected limb is the most common finding. The affected limb lies by the side of the trunk in internal rotation, elbow extension with wrist flexion (Policeman’s tip hand). Presence of Horner’s syndrome and respiratory distress are signs of severe injury.

Children with BPBP need repeated clinical examinations to assess recovery of nerves. This is plotted as scores on the proforma for future reference and comparison.

Other studies which are usually ordered include:

  • X rays of the affected arm to rule out any fracture of the collar or arm bone.
  • Mri of the brachial plexus to look for root avulsion, neuroma and to plan for surgery. However, Mri doesn’t always correlate with the clinical examination.
  • USG and Mri of the shoulder to rule out glenohumeral dysplasia and dislocation in cases of residual bpbp.

Treatment : Physiotherapy with active and passive range of motion exercises, stretching of tight/ contracted muscles and electrical stimulation of weak or paralysed muscles is the mainstay of treatment in majority of cases. Botox can be tried in cases of dynamic contractures.

In panplexopathy cases, neural reconstruction at an early age has shown good results. In cases of residual BPBP, muscle rebalancing and tendon transfer surgeries are performed. Soft tissue releases of the tight capsuloligamentous tissue is required. In severe internal rotation contractures and in older cases of glenohumeral retroversion, humeral derotation osteotomy and glenoid anteversion osteotomy is required respectively.

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