Chapters authored
Current Concept in the Management of Brachial Plexus Birth Palsy
Most infants with brachial plexus birth palsy with signs of recovery in the first 6 weeks of life will improve spontaneously to have a normal function. However, infants who fail to recover in the first 3 months of life carry the risk of long-term disability. Panplexopathy and Horner’s syndrome carry worst prognosis. Plastic neural reconstruction is indicated for the failure of return of function by 3–6 months. There is no consensus about the ideal timing of intervention, and subject is still open to debate. With microsurgical reconstruction, there is improvement in outcome in a high percentage of patients. However, any of these reconstructions is not strong enough to provide a normal function. Limited shoulder abduction and external rotation are the main elements of limitations in residual brachial plexus birth palsy children. Infants with internal contracture can be benefited with Botulinum toxin injection. Internal rotation contracture release and shoulder-rebalancing surgeries for residual brachial plexus birth palsy patients in the form of tendon transfers for congruent glenohumeral joint clearly benefit patients. Patients with noncongruent glenohumeral joint would need a derotational humeral/glenoid anteversion osteotomy. All the mentioned procedures will substantially improve but not normalize the function in children.
Part of the book: Treatment of Brachial Plexus Injuries