Obstetric brachial paralysis – Mapfre Blogs

Obstetric brachial paralysis is a newborn injury caused by tensileness during childbirth, which affects the brachial plexus and can cause loss of mobility or sensitivity in one arm. Its severity varies according to the nerve roots involved, from minor injuries to complete paralysis.

Obstetric brachial paralysis (PBO) is an injury that affects the brachial plexus, a Set of nerves located at the base of the neck that leave the spinal cord and that innervate their shoulder, arm and hand. As a consequence of this injury there is a loss of mobility or sensitivity in the upper limb. It is a condition that usually occurs in newborns. Obstetric brachial paralysis can vary in severity from a mild weakness to a complete paralysis of the upper limb. It can occur at 0.04-0.3% of live newborns.

Why does it occur?

Brachial plexus injury can occur for different reasons:

• Injury during the delivery process:
  • Vaginal births with difficulties for expulsionmainly shoulder dystocia (the baby’s shoulder is trapped by the maternal pelvic bone), presentation of buttocks, fetal macrosomia, having to perform excessive traction on the baby’s neck.
  • Intense uterine contractions during childbirth or even before birth.
• Lesion during pregnancy: uterine abnormalities or maternal pelvis, fetal malposition, multiparity, macrosomic fetuses, excessive mother’s weight gain.

Pathophysiology

The brachial plexus is formed by the nerve roots C5 to T1. The lesion can affect different roots or trunks of the plexus, which determines the gravity and pattern of paralysis. The injuries can be:

• Neuropraxia: Mild damage with spontaneous recovery in weeks.
• Axonotmesis: more severe damage, with loss of nerve function, but with recovery potential.
• Neurotmes: Complete nerve lesion, with limited or zero recovery, without surgical intervention.

In the PBO, excessive traction It can cause stretching or tear of the nerve roots of the plexusmainly affecting roots C 5 YC 6, which innervate the shoulder and arm muscles.

How is it presented?

Obstetric brachial paralysis is manifested as a decrease in mobility or sensitivity in the upper limb. Signs and symptoms vary according to the severity and location of the lesion:

• Weakness or muscles paralysis of shoulder, arm, forearm or hand.
• Limitation in movements such as abduction, external rotation and elbow flexion. Characteristic position of the arm in adduction and internal rotation.
• Loss of muscle reflexes.
• In severe cases, permanent deformities If it is not treated in time.

Generally, it affects a single upper member; In less than 5% of cases, PBO is bilateral. In less than 10% of cases, some other injury could coexist, such as clavicle fracture, humerus fracture, etc.

Obstetric brachial paralysis is classified according to the extension and location of the lesion:

• Erb-Duchenne paralysis: It is the most frequent, mainly affecting roots C5 and C6. It is characterized by weakness or paralysis of the Biceps Deltoids and muscles of the rotator sleeve. The baby presents a characteristic position: arm in adduction, internal rotation and extension of the elbow with a hand in a pitch or claw.
• Klumbke paralysis: mainly affects roots C8 and T1. It is characterized by weakness or paralysis of the muscles of the hand and wrist. It may be associated with a more distal lesion and cause deformities in hand like the hand in claw.
• Complete lesions: They affect the entire brachial plexus from C5 to T1, producing a total paralysis of the upper limb.

The diagnosis is usually clinical, based on the obstetric history and the physical examination of the newborn.

How is it?

In this pathology, physiotherapy and rehabilitator treatment is crucial. The family must be instructed for the realization of postural treatments, mobilizations and exercises. Its involvement in treatment is essential to obtain the best possible evolution. In very selected and more serious cases other treatments such as botulinum toxin or even surgery could be necessary.

In these cases it is vitally important to have experts who accompany you and diagnose as soon as possible. As in Mapfre health insurance, which have great pediatrics and neonates specialists.

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What is the prognosis?

A 80-90% of cases recover in the first months of vineA, but functional sequelae of different gravity could be left, up to 20-30% of cases.

There is no image study that can predict at the beginning with reliability the prognosis and evolution of this injury.

Can it be prevented?

There is no proven efficacy measure to predict or prevent obstetric brachial paralysis.

What you should know …

• Obstetric brachial paralysis (PBO) is a brachial plexus injury in newborns, mainly caused by traction during complicated delivery, which causes loss of mobility or sensitivity in one arm.
• Its severity varies from minor injuries with spontaneous recovery to complete paralysis that may require surgery; The type of injury (ERB-Duchenne, Klumpke or total) depends on the affected nerve roots.
• The treatment is based on physiotherapy and family involvement is very important, with a good prognosis in most cases, although up to 30% can remain with sequelae; There is no effective way to prevent it.