EARLY COMBINED NEUROSURGERY AND ORTHOPAEDIC SURGERY IN NEONATAL BRACHIAL PLEXUS PALSY

Three cases are presented in which neurosurgical reconstruction of a Neonatal Brachial Plexus Palsy was combined with orthopaedic reconstruction of a posterior glenohumeral dislocation. The authors believe that a combined procedure is indicated if the neurological deficit meets the criteria for neural reconstruction and the complication of a posterior glenohumeral dislocation has occurred prior to nerve surgery. Two children with C5–6 lesions and a third child with a pan-plexus lesion obtained good shoulder function following the combined reconstruction.

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Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.10.peds15543 ◽

2016 ◽

Vol 17 (5) ◽

pp. 618-624 ◽

Cited By ~ 9

Author(s):

Thomas J. Wilson ◽

Kate W. C. Chang ◽

Suneet P. Chauhan ◽

Lynda J. S. Yang

Keyword(s):

Brachial Plexus ◽

Prediction Algorithm ◽

University Of Michigan ◽

Brachial Plexus Palsy ◽

Factors Associated ◽

Neonatal Brachial Plexus Palsy ◽

Active Range Of Motion ◽

Wide Range ◽

Nerve Surgery ◽

The University

OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.

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Outcome of secondary shoulder surgery in children with neonatal brachial plexus palsy with and without nerve surgery treatment history: A long-term follow-up study

Journal of Rehabilitation Medicine ◽

10.2340/16501977-2193 ◽

2016 ◽

Vol 48 (7) ◽

pp. 609-617 ◽

Cited By ~ 4

Author(s):

M Holst ◽

C Wal ◽

R Wolterbeek ◽

W Pondaag ◽

T Vlieland ◽

...

Keyword(s):

Brachial Plexus ◽

Shoulder Surgery ◽

Brachial Plexus Palsy ◽

Treatment History ◽

Follow Up Study ◽

Neonatal Brachial Plexus Palsy ◽

Long Term Follow Up ◽

Nerve Surgery

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Nerve surgery for neonatal brachial plexus palsy

Journal of Pediatric Rehabilitation Medicine ◽

10.3233/prm-2011-0166 ◽

2011 ◽

Vol 4 (2) ◽

pp. 141-148 ◽

Cited By ~ 21

Author(s):

Martijn J.A. Malessy ◽

Willem Pondaag

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Palsy ◽

Neonatal Brachial Plexus Palsy ◽

Nerve Surgery

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Extending the Indications for Primary Nerve Surgery in Obstetrical Brachial Plexus Palsy

BioMed Research International ◽

10.1155/2014/627067 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Stuart A. Bade ◽

Jenny C. Lin ◽

Christine G. Curtis ◽

Howard M. Clarke

Keyword(s):

Brachial Plexus ◽

Surgical Intervention ◽

External Rotation ◽

Shoulder Function ◽

Small Subset ◽

Brachial Plexus Palsy ◽

Surgical Indications ◽

Obstetrical Brachial Plexus Palsy ◽

Spontaneous Improvement ◽

Nerve Surgery

Purpose.This study identifies a small subset of patients with obstetrical brachial plexus palsy who, while they do not meet common surgical indications, may still benefit from primary nerve surgery.Methods.Between April 2004 and April 2009, 17 patients were offered primary nerve surgery despite not meeting the standard surgical indications of the authors. The authors performed a retrospective analysis of these 17 patients using prospectively collected data.Results.This group of 17 patients were identified as having poor shoulder function at about 9 months of age despite passing the Cookie Test. Fourteen patients underwent surgical intervention and three families declined surgery. All patients in the operative group regained some active external rotation after surgery. Five patients in this group have required further interventions. Two of the three patients for whom surgery was declined have had no subsequent spontaneous improvement in active external rotation.Discussion.The commonly used indications for primary nerve surgery in obstetrical brachial plexus palsy may not adequately identify all patients who may benefit from surgical intervention. Patients who pass the Cookie Test but have poor spontaneous recovery of active shoulder movements, particularly external rotation, may still benefit from primary nerve surgery.

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