Presentation is loading. Please wait.

Presentation is loading. Please wait.


Similar presentations

Presentation on theme: "CASE CONFERENCE Suying Lam, MD PGY1."— Presentation transcript:


2 Presentation: FT male with L upper extremity weakness Born via NSVD
Nuchal cord x 1 not tight Apgar: 9 at 1 minute; 9 at 5 minutes

3 Physical Exam VS: Weight: 4kg Length: 53 cm Head circumference: 36 cm
T: F HR: x’ RR: x’ BP: UE: LE: Weight: 4kg Length: 53 cm Head circumference: 36 cm Chest circumference: 35 cm Abdominal circumference: 33.5

4 Physical Exam General: alert, NAD, macrosomic Skin: pink
HEENT: AFOF, + molding, + swelling Patent nares, no cleft, no pits Thorax: symmetric expansion Lungs: clear, equal breath sounds Heart: RRR, no murmurs Abdomen: soft, NT, ND, BS+ Extremities: FROM R UE and both LE L UE: (+)abduction, (+)flexion but not against gravity. Position: adducted, internally rotated, elbow extended, forearm pronated, wrist and fingers flexed. Reflexes: asymmetric moro reflex, sucking +, grasp +

5 Neonatal Brachial Plexus Palsies
Smellie 1779 Duchenne and Erb 1870’s Klumpke 1885

6 Brachial Plexus Anatomy

7 Risk Factors Average vertex: 3.8-5 Kg Average breech: 1.8-3.7 Kg
Large birth weight Average vertex: Kg Average breech: Kg Breech presentation Maternal diabetes Multiparity Second stage of labor that lasts more than 60 minutes Assisted delivery (mid/low forceps, vacuum extraction) Forceful downward traction on the head during delivery Previous child with OBPP Intrauterine torticollis Shoulder dystocia

8 Causes Obstetric trauma:
Clavicular fracture Humeral fracture Shoulder dislocation or subluxation Intrauterine compressive brachial plexus palsy Humeral osteomyelitis Neonatal Hemangiomatosis Exostosis of the first rib Neoplasm's (neuromas, rhabdoid tumors)

9 Differential Diagnosis
Pyramidal Tract Lesions Pre-brachial plexus lesions Cervical Spinal Cord Injury Amyoplasia Congenita (arthrogryposis) Pseudoparalysis secondary to pain (humeral fracture) Anterior horn cell injury (congenital varicella or congenital cervical spinal atrophy

10 Diagnosis Laboratory: generally not necessary Imaging studies:
Chest X-ray CT myelography High-resolution MRI Other tests: Electrodiagnostic studies (2-3 weeks after injury) Nerve conduction Studies Glucose levels: macrosomic baby

11 Complete Brachial Plexus Palsy

12 Duchenne-Erb Palsy C5-C6
Position: internally rotated, adducted, elbow extended, forearm is pronated, wrist is flexed and adducted, and fingers are flexed.

13 Upper middle trunk brachial plexus palsy
C5-C6-C7 Difference with Erb’s palsy: wrist is in neutral position (wrist flexor and extensors are equally weak)

14 Klumpke Palsy C8-T1 Floppy hand: wrist is flexed, fingers extended following the forces of gravity Horner’s syndrome

15 Fascicular brachial plexus palsy
One muscle or a group of muscles in the arm Due to injury of a small group of motor fibers

16 Management Rest period of 7 days  pin the sleeve of neonate’s shirt to hold the elbow in a flexed position Physical Therapy Goals: minimizing bony deformities and joint contractures, while optimizing functional outcomes Passive and Active ROM exercise Bimanual activities Strengthening Promotion of sensory awareness Weight-bearing activities: propioceptive input + skeletal growth Static and dynamic splints Instructing parents and family: home exercise program

17 Surgical Intervention
Other treatments: Neuromuscular electrical stimulation Botulinum toxin A therapy Surgical Intervention

18 Prognosis 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 prognosis Peripheral 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 palsy 6-7 months in upper-middle trunk palsy 14 months for a total BPP.

Download ppt "CASE CONFERENCE Suying Lam, MD PGY1."

Similar presentations

Ads by Google