Search Our Scientific Publications & Authors

Neurologia (Engl Ed) 2022 May 24;37(4):243-249. Epub 2021 Apr 24.

Servicio de Neurofisiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain.

Introduction: Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder, typically presenting with recurrent episodes of mononeuropathy in nerves susceptible to compression, with similar neurophysiological characteristics. However, other clinical and neurophysiological presentations have been reported.

Methods: We retrospectively analysed the clinical and neurophysiological characteristics of 20 patients with genetically confirmed HNPP. Read More

Childs Nerv Syst 2022 May 10. Epub 2022 May 10.

Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Purpose: Perinatal brachial plexus palsy (PBPP) has a wide spectrum of clinical symptoms that can range from incomplete paresis of the affected extremity to flaccid arm paralysis. Although there is a high rate of spontaneous recovery within the first two years of life, it remains challenging to determine which patients will benefit most from surgical intervention. The diagnostic and predictive use of various imaging modalities has been described in the literature, but there is little consensus on approach or algorithm. Read More

Rev Bras Ortop (Sao Paulo) 2022 Feb 21;57(1):103-107. Epub 2022 Jan 21.

Departamento de Cirurgia da Mão, Santa Casa da Misericórdia de São Paulo, Faculdade de Ciências Médicas, São Paulo, SP, Brasil.

 To evaluate elbow flexion in children with obstetric brachial plexus paralysis submitted to Oberlin transfer.  Retrospective study with 11 patients affected by paralysis due to labor who did not present spontaneous recovery from elbow flexion until 12 months of life, operated between 2010 and 2018.  The children were operated between 5 and 12 months of life, with a mean of 7. Read More

J Orthop Res 2021 Nov 23. Epub 2021 Nov 23.

Department of Orthopedic Surgery, Columbia University, New York, New York, USA.

Neonatal brachial plexus palsy (NBPP) occurs in approximately 1.5 of every 1,000 live births. The majority of children with NBPP recover function of the shoulder. Read More

Childs Nerv Syst 2021 09 1;37(9):2865-2871. Epub 2021 Jul 1.

Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.

Purpose: This study aimed to investigate the gross motor functions including head control, midline crossing, and rolling, and the relationship between these developmental skills and upper extremity skill quality in children with neonatal brachial plexus palsy (NBPP).

Methods: A total of 106 children with NBPP, aged 10-18 months, were included in this study. Injury severity was determined with the Narakas Classification. Read More

Pan Afr Med J 2021 26;38:309. Epub 2021 Mar 26.

Unité de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de Bouaké, Bouaké, Côte d'Ivoire.

Introduction: obstetrical brachial plexus palsy is a relatively rare condition that has not disappeared although important progress has been made in obstetrics. The purpose of this study is to analyze the epidemiological, clinical, therapeutic and evolutionary features of this disorder in our context.

Methods: we conducted a retrospective study of the medical records of newborns with obstetrical brachial plexus palsy treated at the Bouaké University Hospital over a period of two years. Read More

J Pediatr 2021 Oct 17;237:312-313. Epub 2021 Jun 17.

Department of Pediatrics, Baby Memorial Hospital, Kozhikode, Kerala, India.

J Reconstr Microsurg 2021 Oct 14;37(8):704-712. Epub 2021 Apr 14.

Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut, Egypt.

Background:  Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Read More

J Perinatol 2021 07 31;41(7):1590-1594. Epub 2021 Mar 31.

Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel.

Objective: To evaluate the incidence of brachial plexus birth palsy (BPBP) in a large, single cohort and stratify clinical 1-year outcomes.

Study Design: A cohort study of all births occurring at a single institution between 2011 and 2015. Hospital discharge papers were analyzed, and structured telephone interviews were conducted. Read More

Hand (N Y) 2022 01 11;17(1):NP5-NP11. Epub 2021 Mar 11.

Washington University School of Medicine in St. Louis, MO, USA.

Urgent surgical intervention for amniotic band sequence (ABS) is currently indicated for concerns of vascular compromise and progressive lymphedema. Peripheral motor nerve palsies are rare, and reports of surgical intervention in these cases describe persistent motor dysfunction. We report band release and ulnar, median, and radial nerve decompression in a 1-week-old with a severe upper extremity constriction band and signs of ulnar nerve motor dysfunction. Read More

Medicine (Baltimore) 2020 Aug;99(34):e21830

Department of Orthopedics, Akron Children's Hospital, Akron.

Brachial plexus birth palsy (BPBP) is a neurologic injury that can result in mild to full paralysis of the affected upper extremity. In severe cases, nerve surgery is often performed before age 1 year. Several studies report gains in elbow flexion with onabotulinum toxin type A (OBTT-A) injections to the triceps; however, its use in infants is not widely reported. Read More

Rev Neurol 2020 Jul;71(1):1-10

Fisioterapia pediátrica, Murcia, España.

Introduction: Obstetric brachial palsy is involved with affected upper limb, resulting in permanent structural and function sequelae that limit the motion articular range and reduce independence in daily activities, as well as the children participation in their natural environment.

Aim: To describe the physiotherapy treatments currently used to increase the affected upper limb functionality in children from 0 to 10 years diagnosed with obstetric brachial palsy.

Patients And Methods: A bibliographic search of published studies between 2009 and 2018 was carried out in the PubMed, PEDro, ScienceDirect and The Cochrane Library databases. Read More

Dev Med Child Neurol 2020 06 7;62(6):763. Epub 2020 Mar 7.

Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, UK.

Einstein (Sao Paulo) 2020 27;18:eAO5051. Epub 2020 Jan 27.

Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brazil.

Objective: To study the anatomy of the brachial plexus in fetuses and to evaluate differences in morphology during evolution, or to find anatomical situations that can be identified as the cause of obstetric paralysis.

Methods: Nine fetuses (12 to 30 weeks of gestation) stored in formalin were used. The supraclavicular and infraclavicular parts of the brachial plexus were dissected. Read More

J Vis Exp 2019 12 19(154). Epub 2019 Dec 19.

School of Biomedical Engineering, Science and Health Systems, Drexel University.

Neonatal brachial plexus palsy (NBPP) is a stretch injury that occurs during the birthing process in nerve complexes located in the neck and shoulder regions, collectively referred to as the brachial plexus (BP). Despite recent advances in obstetrical care, the problem of NBPP continues to be a global health burden with an incidence of 1.5 cases per 1,000 live births. Read More

J Pediatr Surg 2020 Feb 5;55(2):240-244. Epub 2019 Nov 5.

Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address:

Background: Phrenic nerve injury (PNI) from birth trauma is a recognized phenomenon, generally occurring with ipsilateral brachial plexus palsy (BPP). In severe cases, PNI results in diaphragm paresis (DP) and respiratory insufficiency. Surgical diaphragmatic plication (SDP) is a potential management strategy for patients with PNI and DP, but timing and outcomes associated with SDP have not been rigorously studied. Read More

Eur J Orthop Surg Traumatol 2019 Feb 8;29(2):329-336. Epub 2019 Jan 8.

Department of Οrthopedics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45500, Ioannina, Greece.

Neonatal brachial plexus palsy is a devastating complication after a difficult delivery. The incidence of this injury has not significantly decreased over the past decades, despite all the advances in perinatal care. Although primary repair of the nerves with microsurgical techniques is the common treatment strategy nowadays, there are late cases in which secondary procedures in tendons or bones are necessary. Read More

Childs Nerv Syst 2019 02 4;35(2):349-354. Epub 2019 Jan 4.

Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil.

Purpose: The outcome from microsurgical reconstruction of neonatal brachial plexus palsy (NBPP) varies, and comparison between different series is difficult, given the differences in preoperative evaluation, surgical strategies, and outcome analysis. To evaluate our results, we reviewed a series of children who underwent surgical treatment in a period of 14 years.

Methods: We made a retrospective review of 104 cases in which microsurgical repair of the brachial plexus was performed. Read More

BMJ Case Rep 2018 Nov 8;2018. Epub 2018 Nov 8.

Department of Pediatrics, Division of Neonatology, Regina General Hospital, Regina, Saskatchewan, Canada.

Brachial plexus birth injury (BPBI) and phrenic nerve injury can sometimes occur concurrently in neonates following difficult deliveries like breech presentation, shoulder dystocia, forceps or vacuum extraction. Phrenic nerve palsy should be suspected in a newborn with respiratory distress and an elevated hemidiaphragm on the imaging studies in presence of the associated risk factors. The right side is affected more often than the left side and most of it is associated with BPBI. Read More

J Shoulder Elbow Surg 2019 Jan 6;28(1):28-35. Epub 2018 Sep 6.

Department of Orthopaedic Surgery and Traumatology, School of Medicine, Koç University, Istanbul, Turkey.

Background: Latissimus dorsi (LD) and teres major (TM) tendon transfers are effective surgical procedures to improve shoulder abduction and external rotation for children with obstetrical brachial plexus palsy (OBPP). Open pectoralis major (PM) tendon Z-plasty and arthroscopic subscapularis (SS) release are 2 options for the release of internal rotation contractures to enhance muscle transfers. This study compared the functional results of LD and TM tendon transfers with open PM tendon Z-plasty or arthroscopic SS release. Read More

Med Hypotheses 2018 Sep 6;118:139-141. Epub 2018 Jul 6.

Gynecologic and Obstetric Department, Nuovo Ospedale delle Apuane, Via Enrico Mattei 21, Massa Carrara, Italy.

Shoulder dystocia is a rare but severe obstetric complication associated with an increased risk of brachial plexus palsies, fractures of the clavicle and humerus, hypoxic-ischemic encephalopathy and, rarely, neonatal death. Here we describe a fatal case of shoulder dystocia in a term newborn, although labor was uneventful, fetal heart rate tracing was normal until the delivery of the head and the head-to-body delivery interval (HBDI) occurred within 5 min. Full resuscitation was performed for 35 min without success. Read More

BMJ Case Rep 2018 May 12;2018. Epub 2018 May 12.

Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA.

We report a preterm neonate born with respiratory distress. The neonate was found to have diaphragmatic palsy and brachial palsy. The neonate was born by caesarean section and there was no history of birth trauma. Read More

Hand (N Y) 2019 03 13;14(2):150-154. Epub 2018 Mar 13.

1 University of Florida Health, Gainesville, USA.

Background: Most brachial plexus birth injuries (BPBIs) are caused by traction on the brachial plexus during a difficult delivery. Fortunately, the possibility of complete recovery from such an incident is relatively high, with only 10% to 30% of patients having prolonged and persistent disability. These patients have muscle imbalances and co-contractions typically localized around the shoulder and elbow. Read More

Childs Nerv Syst 2017 Sep 24;33(9):1571-1574. Epub 2017 Jun 24.

Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, University of Sao Paulo Medical School, Rua Ovidio Pires de Campos, 785, São Paulo, SP, CEP 01060-970, Brazil.

Purpose: Ulnar and median nerve transfers to arm muscles have been used to recover elbow flexion in infants with neonatal brachial plexus palsy, but there is no direct outcome comparison with the classical supraclavicular nerve grafting approach.

Methods: We retrospectively analyzed patients with C5-C7 neonatal brachial plexus palsy submitted to nerve surgery and recorded elbow flexion recovery using the active movement scale (0-7) at 12 and 24 months after surgery. We compared 13 patients submitted to supraclavicular nerve grafting with 21 patients submitted to distal ulnar or median nerve transfer to biceps motor branch. Read More

J Hand Surg Eur Vol 2017 Sep 19;42(7):706-709. Epub 2017 Jun 19.

Scottish National Brachial Plexus Injury Service, Queen Elizabeth University Hospital and Royal Hospital for Children, Glasgow, UK.

In this study, we report the outcome for spontaneous recovery of elbow flexion in obstetric brachial plexus injury managed without nerve reconstruction. Excluding those with transient paralysis, our records revealed 152 children with obstetric brachial plexus injury born before our unit routinely offered brachial plexus reconstruction. Five had had nerve repairs. Read More

J Bone Joint Surg Am 2017 May;99(9):778-783

1Department of Orthopaedic Surgery (A.S.B.) and Clinical Research Center (L.A.K.), Boston Children's Hospital, Boston, Massachusetts 2Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California 3University of California Davis School of Medicine, Sacramento, California 4Shriners Hospitals for Children-Northern California, Sacramento, California.

Background: Early detection of posterior shoulder dislocation in infants with brachial plexus birth palsy (BPBP) is essential, but it may be difficult to accomplish with physical examination alone. The aim of this study was to determine the prevalence of shoulder dislocation in patients with BPBP using ultrasound and to identify which physical examination measurements correlated most with dislocation in these patients.

Methods: This study was a retrospective review of data obtained in an ultrasound screening program of infants with BPBP born from January 2011 to April 2014. Read More

Ir Med J 2016 Aug 8;109(7):434. Epub 2016 Aug 8.

UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland.

J Child Neurol 2016 12 21;31(14):1628-1630. Epub 2016 Sep 21.

Department of Obstetrics, King Saud University, Riyadh, Saudi Arabia

Data of 829 infants with obstetric brachial plexus palsy were reviewed to identify any cases that could not be fitted into the any of the well-known types of palsy. These unusual cases were studied in detail with regard to clinical presentation and electrophysiological findings as well as management and spontaneous motor recovery. Erb's, extended Erb's, and total palsies were seen in 42. Read More

Pediatr Infect Dis J 2016 10;35(10):1151-3

From the *Pediatric Infectious Diseases and Vaccinology, †Department of Pediatric Pharmacology, University of Basel Children's Hospital, Basel, Switzerland; ‡Department of Pediatrics, The University of Melbourne, Parkville, Australia; and §Department of Neuropediatrics, University of Basel Children's Hospital, Basel, Switzerland.

Osteoarticular infections in the newborn period are rare. A serious complication is paralysis of the affected extremity resulting from either pain or direct involvement of the nerve. We report a newborn with combined osteomyelitis and suppurative arthritis caused by Streptococcus pyogenes presenting with right brachial plexus palsy. Read More

J Neuroimaging 2017 03 8;27(2):248-254. Epub 2016 Sep 8.

Boston Children's Hospital, Orthopedic Center, Boston, MA.

Background And Purpose: The current prognostic biomarker of functional outcome in brachial plexus birth palsy is serial clinical examination throughout the first 6 months of age. This can delay surgical treatment and prolong parental anxiety in neonates who will recover spontaneously. A potentially superior biomarker is a volumetric proton density MRI performed at clinical presentation and within the first 12 weeks of life, providing a high spatial and contrast resolution examination in 4 minutes. Read More