Management of obstetric brachial plexus lesions: state of the art and future developments

Childs Nerv Syst. 2000 Nov;16(10-11):638-44. doi: 10.1007/s003810000319.

Abstract

Despite improving perinatal care the incidence of obstetric brachial plexus lesions (OBPL) has not declined. Most babies recover spontaneously. In 10-20% recovery is incomplete. To prevent lasting functional deficits early referral to specialized centers is necessary. If the biceps shows no function at 3 months, standardized clinical assessment and additional investigations must delineate the extent of a lesion. Detection of root avulsions by myelography and computed tomography combined with electrodiagnostics remains inconclusive in 15% of cases. Plexus reconstruction is performed during the 4th-6th months. Contractures or deformities are treated conservatively or by orthopedic surgery. Long-term rehabilitation is required. In future, aspects of prevention need attention. Improving imaging and neurophysiological techniques are promising for greater precision in detecting root avulsions and even spontaneous recovering nerves. Functional imaging will allow better understanding of central integration and plasticity. New pharmacological agents may promote nerve regeneration.

MeSH terms

  • Birth Injuries / diagnosis
  • Birth Injuries / surgery*
  • Brachial Plexus / injuries*
  • Brachial Plexus / surgery
  • Female
  • Humans
  • Infant, Newborn
  • Microsurgery
  • Neurologic Examination
  • Patient Care Team
  • Pregnancy
  • Prognosis
  • Spinal Nerve Roots / injuries