What is Obstetric Brachial Plexus Palsy?

Obstetric Brachial Plexus Palsy refers to a medical condition in which there is paralysis of the arm as a result of injury to the nerves originating behind the neck and going down the arm. This injury to the nerves in Obstetric Brachial Plexus Palsy is normally caused due to some difficulty in the delivery of the child at the time of the birth. This condition is commonly referred to as Klumpke Palsy.

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The injury to the nerves due to Obstetric Brachial Plexus Palsy affects the functioning of the muscles of the arm, wrist, and hand. In some cases Obstetric Brachial Plexus Palsy can also be caused due to a physical trauma at the time of birth or just after it.

A tumor to the shoulder or lung also can affect the nerves of the shoulder and arms causing Obstetric Brachial Plexus Palsy. This happens when the tumor puts pressure on the nerves and compresses them.

What Causes Obstetric Brachial Plexus Palsy?

As stated, Obstetric Brachial Plexus Palsy is in most cases caused due to a difficult delivery of a baby. The injury to the nerves during childbirth causing Obstetric Brachial Plexus Palsy occurs in vaginal deliveries with the most common reason being high birth weight of the baby and the mother being small in stature.

A baby tends to have increased birth weight in mothers who suffer from either gestational diabetes or are chronically diabetic. In some cases, during delivery the baby has to be pulled from the birth canal by hands. This in some cases results in injury to the nerves causing Obstetric Brachial Plexus Palsy. [1]

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What are the Symptoms of Obstetric Brachial Plexus Palsy?

The classic presenting features of Obstetric Brachial Plexus Palsy include atrophied muscles of the hands, symptoms of Horner syndrome to include ptosis of the eyes and face. The affected individual is not able to use the affected hand normally. There may also be paralysis of the affected hand. [1]

Numbness and tingling of the affected upper extremity is also something that is seen in children with Obstetric Brachial Plexus Palsy. The affected extremity is also quite painful for the child. The joints become so stiff that it becomes very difficult to move the hand or arm. The muscles of the affected hand also become extremely weak making it difficult for the child to lift, grip, push or pull objects. [1]

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How is Obstetric Brachial Plexus Palsy Treated?

Obstetric Brachial Plexus Palsy can be treated both conservatively as well as surgically. The conservative approach towards treatment of this condition include

Intense Physical Therapy- This mode of treatment is quite effective for mild cases of Obstetric Brachial Plexus Palsy. The therapy is aimed at strengthening the muscles of the affected hand and improving range of motion. The child is required to perform the exercises diligently to facilitate healing and prevent any stiffness of the joints of the wrist, elbow, and the shoulders.

Medications- Physicians often prescribe medications to treat the pain, numbness, and tingling that is often caused due to Obstetric Brachial Plexus Palsy. There are various ointments that can be applied topically and prescription medications which can be effectively used to treat this condition.

Coming to surgical options, this route is taken when the above mentioned conservative measures do not prove effective in improving the symptoms of Obstetric Brachial Plexus Palsy despite following the instructions of the physician diligently. The surgery is aimed at repairing the damaged nerves. This is done by the following methods.

Muscle Transfer- This procedure is done to provide support to the weak muscles of the affected arm. In this procedure, healthy muscle from another area of the body is taken out and transferred to the affected arm to support the weak muscle. This method has proved to be quite effective in treating muscle weakness caused by Obstetric Brachial Plexus Palsy.

Nerve Transfer- This is yet another procedure that is quite an effective option for treating Obstetric Brachial Plexus Palsy. This procedure is similar to the muscle transfer where healthy nerve from another part of the body is replaced with the injured nerve thus treating the condition and restoring normal functioning of the hand.

The recovery postsurgery of the nerves is extremely slow and it tends to take years before normal functioning of the hand returns. Postsurgery, the patient will have to undergo aggressive rehab to improve strength and range of motion of the affected hand. [1]

What Is The Overall Prognosis Of Obstetric Brachial Plexus Palsy?

Studies have revealed that prognosis for Obstetric Brachial Plexus Palsy in young infants who are diagnosed within the first few months of life are much better than children who are diagnosed much later despite surgery.

This normally has to do with the length of the nerve or muscle that needs to be transferred and faster recovery of the nerves. Moreover, if the condition is diagnosed early and treatment is done then by the time the child reaches three to four years of life the child regains almost all the function of the affected hand.

Mild cases of Obstetric Brachial Plexus Palsy can resolve on their own without treatments but severe cases require surgery for treating Obstetric Brachial Plexus Palsy in its entirety. However, there have been some cases where the nerve damage is so extensive that the child may be left with permanent disabilities due to Obstetric Brachial Plexus Palsy. [1]

Reference-

  1. https://www.ncbi.nlm.nih.gov/books/NBK531500/

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Sheetal DeCaria MD

Written, Edited or Reviewed By:

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Last Modified On: April 19, 2019

This article does not provide medical advice. See disclaimer

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