Obstetric lesions of the brachial plexus

The few studies on prognosis of obstetric lesions of the brachial plexus that are not hampered by selection bias or a short follow‐up suggest that functional impairment persists in 20–25% of cases, more than commonly thought. Electromyography (EMG), potentially useful for prognosis, is often conside...

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Bibliographic Details
Published in:Muscle & nerve 2001-11, Vol.24 (11), p.1451-1461
Main Authors: van Dijk, J. Gert, Pondaag, Willem, Malessy, Martijn J. A.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Birth Injuries - pathology
Birth Injuries - physiopathology
brachial plexus
Brachial Plexus - injuries
Brachial Plexus - pathology
Delivery. Postpartum. Lactation
Disorders
Electromyography
electromyography (EMG)
Gynecology. Andrology. Obstetrics
Humans
Infant
Medical sciences
obstetric nerve repair
Prognosis
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Summary:The few studies on prognosis of obstetric lesions of the brachial plexus that are not hampered by selection bias or a short follow‐up suggest that functional impairment persists in 20–25% of cases, more than commonly thought. Electromyography (EMG), potentially useful for prognosis, is often considered of little value. Denervation in the first week of life has been interpreted as evidence of an antenatal lesion, but is the logical result of the short axonal length affected. EMG performed at close to the time of possible intervention (3 months) usually shows a discrepancy: motor unit potentials are seen in clinically paralyzed muscles. This can be explained in five ways: an overly pessimistic clinical examination; overestimation of EMG recruitment due to small muscle fibers; persistent fetal innervation; developmental apraxia; or misdirection, in which axons reach inappropriate muscles. Further research into the pathophysiology of obstetric lesions of the brachial plexus is needed to improve prognostication. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 1451–1461, 2001
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.1168