PeripheralNerves.com

Obstetric Brachial Plexus Palsy (OBPP) 

Sub-topics

Introduction / Aetiology / Classification / Clinical Features / 

Diagnosis (Electrophysiology)  / Prognosis / Treatment / Surgery / 

Results / Late Effects of OBPP.

Classification

The commonly used classification is the one given by Gilbert and Tassin. It is recommended that it be used 2 to 4 weeks after birth which gives a simple neuropraxia time to recover. This enables a clearer picture of the nerve damage. The other advantage of this classification is that it enables us to predict the prognosis.

Horner's syndrome is a combination of miosis (constricted pupils), anhydrosis (loss of sweating), ptosis (drooping eyelids) and enopthalmos (sunken eyeballs). It is a sign of sympathetic chain paralysis.  

This system unfortunately doesn't recognise the isolated C8, T1 (Klumpke's) palsy. Another pattern is that upper and middle nerves recover and the middle remain affected.

Clinical Features

Children present with different degree affliction. C5 nerve root innervates the shoulder. C6 elbow flexion. C7 elbow, wrist and finger extension. C8 T1, hand grip. We are able to tell which roots of the plexus are damaged by examining for the pattern of loss of movement.

It is surprising to find little evidence of anaesthesia/ loss of sensibility and sympathetic function seems to recover.

Children with favourable lesions get a powerful grasp in 2 to 4 weeks. Elbow flexion and shoulder movements return in 6-8 weeks. Although there are debates on this most surgeons are worried when elbow flexion does not return by 12 weeks age. We think this should not be used as a absolute watershed and that electrophysiological testing is indicated before deciding on surgery. There are always children who do not follow the pattern and defy conventions.

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Last modified: July 02, 2002