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Shoulder dystocia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, James S. Smeltzer
Many cases of neonatal brachial plexus injury are not associated with recognized shoulder dystocia, some not even with vaginal delivery (9,11,12,46,47). Indeed, Gherman et al. have published a report of six documented cases of brachial plexus injury in infants delivered by cesarean, five of whom were delivered for labor abnormalities but one in which delivery occurred in the absence of active labor (48). Brachial plexus injury has been observed by some (42,49) in the absence of any traction to effect delivery. It is likely that the traction between the locked head and posterior shoulder at the pelvic inlet is sufficient at times to cause harm, even when resolved spontaneously or by McRoberts maneuver.
Fetal and birth trauma
Published in Prem Puri, Newborn Surgery, 2017
Serial physical examination of children with brachial plexus injury is recommended, because it is essential to predict recovery and determine the need for additional therapeutic or surgical intervention. Passive range of motion and active muscle strength should be assessed. Assessing infants often requires approximation of function by observing spontaneous activity and assessing reflexes (Moro reflex, asymmetric tonic neck, and symmetric tonic neck). Most authors agree that brachial plexus lesions are most often transitory, with 75%–95% of cases advancing to complete recuperation.51–53 The most recent studies report a lower rate of 66%, with a residual deficit in 20%–30% and considerable alteration of function in 10%–15% of cases.45,52,54 Total paralysis and the presence of Horner’s syndrome are the main factors announcing a poor prognosis.50 The main principle of management is to maintain the range of “motion” in the affected joints. Treatment should be delayed for a period of 2 weeks after the trauma, in which immobilization of the hand and stretched nerve fibers will allow a spontaneous cure. During the first 2 weeks, the arm has to be adducted to the thorax. Abduction and external rotation position of the shoulder must be prevented due to considerable tension on the brachial plexus in that position. In the other joints, careful passive physiotherapy should be carried out. Thereafter, gentle range-of-motion exercises to shoulder, elbow, wrist, and small joints of the hand may have to be started.
Peripheral nerve disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Michael Fox, David Warwick, H. Srinivasan
The nerve is sometimes ruptured in a brachial plexus injury. More often it is injured during shoulder dislocation or fractures of the humeral neck. Iatrogenic injuries occur in transaxillary operations on the shoulder and with lateral deltoid-splitting incisions. It is sometimes injured at the same time as the suprascapular nerve in shoulder dislocation where it is most commonly injured at its take-off from the posterior cord, just medial to the coracoid process.
The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study
Published in Disability and Rehabilitation, 2021
Sara Brito, Jennifer White, Nikos Thomacos, Bridget Hill
This study highlighted a range of complex factors related to the long term adjustment to brachial plexus injury. A central finding was that participants had limited use of their arm even after the experience of multiple surgeries and rehabilitation. Furthermore, participants’ experienced psychological morbidity frequently characterized by expressions of depression and guilt. This is consistent with previous research demonstrating the impact of brachial plexus injury on psychological health [19,24,36,37]; indicating that psychological support is very often needed post injury and surgeries. However, most participants in this study did not access psychological support despite access to one via their compensable insurance scheme. One reason for this may be that young men are less likely to seek and engage in mental health services [38]. However this study found that participants reported their therapeutic relationships with the rehabilitation team served as consistent, positive connections that meaningfully assisted with adjustment following injury. Whilst not a substitute for professional psychological care, it is known that positive and supportive relationships minimize distress during recovery [2,39].
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
Non-traumatic brachial plexopathies, in general, are rare, with a prevalence of approximately 0.4% in patients with cancer, or 5.0–9.0% of patients treated with radiation to the chest or axilla [4]. Other studies have estimated the prevalence of non-traumatic brachial plexus injury to be approximately 1.64 cases per 100,000 people [5]. The oncogenic or radiation-related neuropathies typically involve the lower brachial plexus, similar to thoracic outlet syndrome, while other common non-traumatic causes such as brachial neuritis frequently involve the upper brachial plexus. By comparison, traumatic brachial plexus injuries are a relatively common form of peripheral neuropathy in both adult and pediatric populations. Motor vehicle accidents (particularly those involving motorcycles), falls, and sports injuries are frequent etiologies for closed trauma to the brachial plexus. The injuries can vary from stretch or traction to nerve root avulsions or ruptures. Other well-described mechanisms of injury include iatrogenic traction injuries in anesthesia, or obstetric-related injuries acquired during childbirth. Most patients suffering from traumatic brachial plexus injury are young men between 15 and 25 years of age [6–8]. Open traumatic causes can occur due to gunshot wounds or lacerations and may be complicated by concomitant injury to the adjacent vascular structures. Other complicating traumatic injuries, such as bone retropulsion into brachial plexus structures, have also been described [9].
Brachial plexus injury: living with uncertainty
Published in Disability and Rehabilitation, 2023
Caroline Miller, Christina Jerosch-Herold, Jane Cross
A brachial plexus injury (BPI) is a devastating injury to the nerves that provide sensation and movement to the upper limb. BPI occurs most commonly in young adults following a road traffic collision [1] and, although rare [1,2], has life-changing consequences for individuals and their families. Despite new treatments, there is evidence that individuals with a BPI continue to suffer emotional and psychological distress [3]. People with BPIs report significant challenges with returning to work [4–6] body image [5,7] and social anxiety [5,7,8] and financial uncertainties exacerbate these concerns [6,8]. Qualitative studies highlight changes in role and identity [4,6], experiences with healthcare [4,6,8], and negative psychosocial impacts [6,7,9].