Obstetric brachial plexus injury

Management of obstetric brachial plexus injury requires understanding of brachial plexus neuroanatomy. Clinical presentations of brachial plexus palsy include terminal branch syndromes, total brachial plexus palsy, bilateral brachial plexus palsy, partial terminal branch deficit, and hand muscle weakness with Horner syndrome. The differential diagnosis includes lesions at different anatomical locations, of different etiologies (non obstetric trauma, congenital chickenpox, amniotic bands,) and pseudoparalysis. Management includes prevention, family support, physical therapy after 7 to 10 days of life, neural repair and tendon transposition. Neural repair should be done at 4 to 6 months of life if no significant improvement occurs, or later in life if the improvement arrests at an unacceptable level for longer than 4 months or deterioration occurs. Tendon transposition may be done after 2 years of age. EMG during the first week of life should not be done routinely. Mothers should have the option to refuse cesearian section when it is recommended to avoid obstetric brachial plexus injury.