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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

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

PM R 2017 Apr 9;9(4):383-391. Epub 2016 Aug 9.

Department of Physical Medicine and Rehabilitation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109-2800(∗∗). Electronic address:

Background: Currently, no published, validated patient-reported outcome (PRO) measures of health-related quality of life (HRQOL) exist for use with neonatal brachial plexus palsy (NBPP). NBPP is a debilitating condition that occurs during the perinatal period, resulting in paralysis/paresis and loss of sensation in the affected arm. Commonly used NBPP measures are not comprehensive and do not fully account for clinically meaningful changes in function or progression of the disorder. Read More

Pediatr Neurol 2016 09 11;62:e1. Epub 2016 Jun 11.

Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.

Pediatr Neurol 2016 Mar 24;56:42-47. Epub 2015 Dec 24.

Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan.

Background: Routine sensory assessments in neonatal brachial plexus palsy are infrequently performed because it is generally assumed that sensory recovery exceeds motor recovery. However, studies examining sensory function in neonatal brachial plexus palsy have produced equivocal findings. The purpose of this study was to examine hand sensorimotor function in older children with neonatal brachial plexus palsy using standard clinical and research-based measures of tactile sensibility. Read More

West Indian Med J 2015 Sep 26;64(4):424-8. Epub 2015 Jun 26.

Dr Paul Brand Centre for Hand and Peripheral Nerve Surgery, Christian Medical College, Vellore, TN, India-632004.

Objective: Birth palsy, otherwise known as obstetric brachial plexus paralysis (OBPP), is a closed stretch injury to the brachial plexus of nerves during the birth process resulting in varying degree of paralysis and contractures of the upper limb. The study aimed to find out the susceptibility of humans and small-bodied primates to birth palsy.

Method: A comparative study on parturition in modern humans, hominoids, hominids, small-bodied primates and great apes was done to determine if the changes in female pelvis and neonatal head and shoulder during human evolution is the real cause for OBPP. Read More

Pan Afr Med J 2015 13;21:283. Epub 2015 Aug 13.

Service de Dermatologie, CHU Ibn Rochd, Casablanca, Maroc.

J Hand Surg Am 2015 Dec 3;40(12):2345-51.e1. Epub 2015 Nov 3.

Division of Plastic Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, WA. Electronic address:

Purpose: To evaluate the presence and degree of glenohumeral dysplasia (GHD) in infants undergoing surgical exploration for neonatal brachial plexus palsy (NBPP) and to identify potential predictive factors of early maladaptive shoulder morphology.

Methods: We included all consecutive patients with NBPP who underwent surgical exploration of their brachial plexus and who had a preoperative magnetic resonance imaging scan at our institution over a 3-year period. Demographic, therapy, and surgical data were collected. Read More

J Pediatr Rehabil Med 2015 ;8(3):167-85; quiz 185-6

Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.

Background: Symptoms of a neonatal brachial plexus palsy (NBPP) can vary widely among individuals and numerous clinical studies have been performed to identify the natural history and to improve treatment. The aim of this study was to identify and describe all outcome measures used in clinical studies on patients with an NBPP and categorize these outcome measures according to the International Classification of Functioning, Disability and Health (ICF).

Method: Electronic searches of different databases were carried out. Read More

PM R 2015 Dec 21;7(12):1235-1242. Epub 2015 May 21.

Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Rm 3552 TC, Ann Arbor, MI 48109-5338.

Background: Children with neonatal brachial plexus palsy (NBPP) are often prescribed shoulder range of motion (ROM) exercises; however, the extent and timing of exercise implementation remains controversial in the context of shoulder joint integrity. The association of ROM exercises to delayed posterior shoulder subluxation (PSS) is unknown.

Objective: To determine prevalence of PSS in children with NBPP who began full passive ROM exercises before 6 months of age, and characteristics associated with development or absence of PSS in children. Read More

J Hand Surg Am 2015 Jun 1;40(6):1246-59. Epub 2015 May 1.

Division of Plastic Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada.

Nerve transfers have gained popularity in the treatment of adult brachial plexus palsy; however, their role in the treatment of neonatal brachial plexus palsy (NBPP) remains unclear. Brachial plexus palsies in infants differ greatly from those in adults in the patterns of injury, potential for recovery, and influences of growth and development. This International Federation of Societies for Surgery of the Hand committee report on NBPP is based upon review of the current literature. Read More

J Hand Surg Am 2015 Jun 25;40(6):1177-83. Epub 2015 Mar 25.

Division of Plastic and Reconstructive Surgery and Department of Rehabilitation Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Purpose: To determine the prevalence and characteristics of pain experienced by children who have had microsurgical reconstruction for obstetrical brachial plexus palsy (OBPP).

Methods: A prospective case series study was conducted of 65 children aged 6 to 18 years with a diagnosis of OBPP and who had microsurgery at less than 12 months of age with nerve grafting or transfer. A total of 28 patients (43%) had upper OBPP and 37 (57%) had total OBPP. Read More

World J Orthop 2015 Jan 18;6(1):156-60. Epub 2015 Jan 18.

Rahul K Nath, Chandra Somasundaram, Texas Nerve and Paralysis Institute, Houston, TX 77030, United States.

Aim: To systematically review and analyze the overall impact and effectiveness of bony surgical procedures, the triangle tilt and humeral surgery in a comparative manner in permanent obstetric brachial plexus injury (OBPI) patients.

Methods: We conducted a literature search and identified original full research articles of OBPI patients treated with a secondary bony surgery, particularly addressing the limitation of shoulder abduction and functions. Further, we analyzed and compared the efficacy and the surgical outcomes of 9 humeral surgery papers with 179 patients, and 4 of our secondary bony procedure, the triangle tilt surgical papers with 86 patients. Read More