Perinatal brachial plexus palsy

Question 1

What is perinatal brachial plexus palsy?

Answer 1

Flaccid paralysis of the arm at birth affecting different nerves of the brachial plexus supplied by C5 to T1

Question 2

What are the CPS recommendations regarding brachial plexus injury?

Answer 2

1. To foster realistic parental expectations, it is important to provide a clear explanation of the nerve injury and its potential sequelae. This should include the following information:
   a) PBPP is not always preventable.
   b) 75% of infants recover completely within the first month of life.
   c) 25% experience permanent impairment and disability.
2. If the physical examination shows incomplete recovery by the end of the first month, referral to a multidisciplinary brachial plexus team should be made. The team should include neurologists and/or physiatrists, rehabilitation therapists and plastic surgeons.
3. Because there are no randomized controlled trials evaluating nonsurgical management versus primary surgical exploration, decisions for primary surgical exploration versus nonsurgical management and prediction of prognosis have to be based on history, electrodiagnostic procedures, diagnostic imaging and physical examination by the multidisciplinary team.
4. Secondary soft tissue and bone reconstructive surgery may improve function in children with significant impairment, but is inferior to primary intervention.
5. Further research is needed to prevent injury, to improve predictive indicators of natural recovery, and to establish better criteria for surgery, nonoperative management and measurement of outcome.