Checkpoint: Pediatric Brachial Plexus-Dr. Justice Presentation

Dr. Justice Presentation

Pdf Summary

The document provides a comprehensive review of neonatal brachial plexus palsy (NBPP), an injury that occurs in approximately 1-4 per 1000 live births. NBPP can result from complications such as shoulder dystocia during vaginal delivery, and the condition can lead to various degrees of lifelong disability, although many children experience spontaneous recovery. <br /><br />The document emphasizes the anatomy of the brachial plexus and categorizes different types of nerve injuries, including Erb’s palsy (affecting the upper trunk), panplexopathy (involving C5-T1), and Klumpke’s palsy (affecting the lower trunk). <br /><br />The report highlights the importance of early referral to interdisciplinary clinics for better outcomes. These clinics provide coordinated care that encompasses medical, surgical, and therapeutic management, allowing for early diagnosis and comprehensive treatment strategies. The initial evaluation should ideally begin within the first week, followed by follow-ups at one month, three months, and six months to monitor progress and plan potential surgeries if recovery is not evident.<br /><br />The interdisciplinary model includes physical medicine and rehabilitation, neurosurgery, plastic surgery, neurology, occupational therapy, and electrodiagnostic studies (EMG). The document describes various diagnostic tools, including MRI, ultrasound, and nerve conduction studies (NCS). Surgical options such as nerve grafts, transfers, and their specific donor-recipient scenarios are detailed.<br /><br />Therapeutic interventions play a critical role in recovery. These include range-of-motion exercises, strengthening, neuromuscular electrical stimulation, constraint-induced movement therapy, and other aids like splinting and adaptive equipment. Post-operative care emphasizes nerve recovery, typically at a rate of one inch per month, and includes car seat management and resuming therapy six weeks post-surgery.<br /><br />The document underscores the significance of a cohesive, interdisciplinary approach to improve patient care, encouraging early and comprehensive treatment to optimize outcomes for children with NBPP.

Keywords

neonatal brachial plexus palsy

NBPP

shoulder dystocia

Erb’s palsy

Klumpke’s palsy

interdisciplinary clinics

nerve injuries

diagnostic tools

therapeutic interventions

surgical options