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Obstetric Brachial Plexus Palsy (OBPP) 

Sub-topics

Introduction / Aetiology / Classification / Clinical Features / 

Diagnosis (Electrophysiology)  / Prognosis / Treatment / Surgery / 

Results / Late Effects of OBPP.

Introduction

The Brachial Plexus can be injured during difficult childbirth. These children are born with paralysis of either hands, forearm, arm and shoulder or a combination of these. Traditionally, this condition also has the synonym of Erb's or Klumpke's palsy. It leads to a waiter tip posture of adducted and internally rotated shoulder, extended elbow, flexed wrist and fingers.

It will be easier to understand this condition if you have look at the Anatomy of the Brachial Plexus. The Brachial plexus is formed by the nerve roots of the Cervical (C) 5, 6, 7, 8 and Thoracic (T) 1st from the spinal cord. The C 5/6 form the upper trunk, C7, the middle trunk and C8 T1, the lower trunk.

The incidence is around 0.2 to 4%. Around 150 new cases a year are seen at one unit in the United Kingdom.

Erb's Palsy is the classical Obstetric Brachial Plexus Palsy (OBPP), a term used for involvement of the upper trunk of the Brachial Plexus. 

Klumpke's Palsy is the acronym for lower trunk palsy affecting mostly the hand and wrist function.

Aetiology

Results from trauma during childbirth. In the breech child the forequarter is separated upwards resulting in damage to the lower roots (C 7/8 T1). Whereas in the shoulder dystocia (shoulder presentation) the forequarter is separated downwards damaging the upper roots C 5/6/7 (Figure 1 and 2).

(Click for larger picture.)

    Figure1                    Figure2                

Risk Factors

Breech delivery of both small and high weight (4.5 kg) babies.

Cephalic delivery in high weight (4.5 kg) babies.

Mothers who are shorter and have a higher weight gain during pregnancy have also been found to be at risk.

Shoulder dystocia is the presentation >60% of OBPP children.

The incidence can be decreased by good obstetric practice but is static because of resurgence of ideas about home delivery/ natural birth.

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Last modified: July 02, 2002