The role of electromyography in the management of the brachial plexus palsy of the newborn (original) (raw)

Brachial plexus birth palsy: an overview of early treatment considerations

Bulletin of the NYU hospital for joint diseases, 2009

Since the description by Smellie in 1764, in a French midwifery text, that first suggested an obstetric origin for upper limb birth palsy, great strides have been made in both diagnosis and early and late treatment. This report presents an overview of selected aspects of this complex and extensive subject. Early treatment options are reviewed in the context of the present controversies regarding the natural history and the indications for and timing of microsurgical intervention in infants with brachial plexus birth injuries.

Clinical assessment, MRI, and EMG in congenital brachial plexus palsy

Pediatric Neurology, 1999

Thirteen infants with congenital brachial plexus palsy (eight with upper, five with upper and lower) were monitored by magnetic resonance imaging (the first performed between 7 and 41 days of age and the second at 3 months of age), electromyography (the first performed between 27 and 50 days and the second at 3 months), and the muscle scoring system of the Hospital for Sick Children (at 3, 6, and 9 months of age). The findings were evaluated with respect to the clinical status of the patients at 12 months of age. Magnetic resonance imaging, which could be performed readily even in the neonatal period, revealed pseudomeningoceles in two of the five patients with a poor prognosis (in all planes even in the early days after birth) and in two of the eight patients with a good prognosis (more easily visible at 3 months of age). Electromyography implied root avulsion in three of five patients with a poor prognosis. Electromyography can be of great value for patients with a poor prognosis and root avulsion but may underestimate the severity. The muscle scoring system (Hospital for Sick Children) was determined to be the most predictive method for prognosis.

Long-term follow-up of children with obstetric brachial plexus palsy I: functional aspects

Developmental Medicine & Child Neurology, 2007

The aim of this study was to examine long-term neurophysiological outcomes and sensory function in patients with obstetric brachial plexus palsy (OBPP). The same 70 children/adolescents examined in part I: functional aspects (35 males, 35 females; age range 7-20y, mean 13y 6mo [SD 4y 3mo], median 13y) were examined with neurophysiological methods at 3 to 7 months and at 7 to 20 years of age. Thirteen of the 70 participants underwent nerve reconstruction before 1 year of age. Electromyography (EMG) was performed on deltoid and first interossei muscles; Quantitative Sensory Test was used for C6 and C8 dermatomes. Tests for functional sensibility and 2-point discrimination for C6 and C8 were performed. This study shows that considerable EMG changes can be observed in OBBP, even in those fully recovered. EMG changes in the deltoid were shown to deteriorate over time, and sensibility is considerably less affected than motor function.

Ultrasonography for neonatal brachial plexus palsy

Journal of Neurosurgery: Pediatrics, 2014

Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asym...

Neonatal brachial plexus palsy: Incidence, prevalence, and temporal trends

Brachial plexus injury Shoulder dystocia Cesarean delivery a b s t r a c t Epidemiological knowledge of the incidence, prevalence, and temporal changes of neonatal brachial plexuses palsy (NBPP) should assist the clinician, avert unnecessary interventions, and help formulate evidence-based health policies. A summary of 63 publications in the English language with over 17 million births and 24,000 NBPPs is notable for six things.

Epidemiology of Brachial Plexus Palsy in Newborns

Paediatrics Today, 2014

The aim of this study was to analyze the frequency of brachial palsy by gender, type, side, the newborn mother's parity and to identify its potential risk factors. Material and methods-Eighty-four newborn infants with brachial palsy were studied retrospectively at the University Clinical Center of Kosovo. The disease was confirmed by physical examination, neurological examination, and radiography. Results-The majority of newborns included in this study were male, with the Erb-Duchene type of brachial palsy. A greater number of newborn infants (70.2%) had sustained injuries to the right side. The most frequent occurrence was to the firstborn baby. Shoulder dystocia (39.3%), macrosomia (16.7%) and vaginal breech delivery (13.1%) were the most frequent potential risk factors identified in this study. The incidence of plexus brachial injury ranges from 1.8 to 3.35, depending on the ordinal number of the mother's delivery. The highest incidence is in mothers on their first-delivery, while the lowest is for those having the second child. The overall average incidence rate of brachial palsy is 2.62 per 1000 newborns. Conclusion-Our study has shown that the incidence of brachial plexus palsy is relatively high in newborns. Newborns with shoulder dystocia, macrosomia, and those born by vaginal breech delivery are at greater risk for brachial plexus palsy. Further research should be focused on the treatment and rehabilitation of children with brachial plexus palsy.

Clinical-Electromyography Correlation in Infants With Obstetric Brachial Plexopathy

The Journal of Hand Surgery, 2007

The real utility of needle electromyography (EMG) for evaluation of infants with obstetric brachial plexopathy remains controversial. The objective of this paper is to evaluate how EMG correlates with clinical evaluation of these patients. Methods: We performed EMG in 41 infants (42 arms) with severe obstetric brachial plexopathy who were from 3 to 12 months of age. We correlated the EMG interference pattern with the clinical assessment of infraspinatus, deltoid, biceps, triceps, and extensor digitorum communis muscles. Results: Motor unit potentials were always present, and abnormal spontaneous activity was not common in proximal muscles. The correlation between EMG interference pattern and clinical assessment was not good, except for extensor digitorum communis. EMG showed higher scores than clinical evaluation for infraspinatus, deltoid, and biceps muscles. Respiratory synkinesis was present in 19 patients, or 45% of the affected arms, and it could involve any muscle innervated from C5 to T1. Conclusions: Needle EMG fails to estimate or overestimates clinical recovery in proximal muscles in this age group. (J Hand Surg 2007;32A:999 -1004.