7Risk Factors Average vertex: 3.8-5 Kg Average breech: 1.8-3.7 Kg Large birth weightAverage vertex: KgAverage breech: KgBreech presentationMaternal diabetesMultiparitySecond stage of labor that lasts more than 60 minutesAssisted delivery (mid/low forceps, vacuum extraction)Forceful downward traction on the head during deliveryPrevious child with OBPPIntrauterine torticollisShoulder dystocia
8Causes Obstetric trauma: Clavicular fractureHumeral fractureShoulder dislocation or subluxationIntrauterine compressive brachial plexus palsyHumeral osteomyelitisNeonatal HemangiomatosisExostosis of the first ribNeoplasm's (neuromas, rhabdoid tumors)
12Duchenne-Erb Palsy C5-C6 Position: internally rotated, adducted, elbow extended, forearm is pronated, wrist is flexed and adducted, and fingers are flexed.
13Upper middle trunk brachial plexus palsy C5-C6-C7Difference with Erb’s palsy: wrist is in neutral position (wrist flexor and extensors are equally weak)
14Klumpke PalsyC8-T1Floppy hand: wrist is flexed, fingers extended following the forces of gravityHorner’s syndrome
15Fascicular brachial plexus palsy One muscle or a group of muscles in the armDue to injury of a small group of motor fibers
16ManagementRest period of 7 days pin the sleeve of neonate’s shirt to hold the elbow in a flexed positionPhysical Therapy Goals: minimizing bony deformities and joint contractures, while optimizing functional outcomesPassive and Active ROM exerciseBimanual activitiesStrengtheningPromotion of sensory awarenessWeight-bearing activities: propioceptive input + skeletal growthStatic and dynamic splintsInstructing parents and family: home exercise program
17Surgical Intervention Other treatments:Neuromuscular electrical stimulationBotulinum toxin A therapySurgical Intervention
18Prognosis 4-5 months in Erb’s palsy Degree of future improvement cannot be determined during a single evaluation, especially if performed immediately after birth.Improvement during the first few weeks is a relatively good indicator of final outcome.Incidence of permanent sequelae: 3-25%Findings consistent with severe initial injury (Horner’s syndrome) portend a less favorable prognosisPeripheral nerves re-myelinate at a rate of 1mm/day. If nerve is not transected, recovery can be expected by:4-5 months in Erb’s palsy6-7 months in upper-middle trunk palsy14 months for a total BPP.