Paralisia braquial obstétrica

OBSTETRIC BRACHIAL PLEXUS INJURIES
BY MOHAMMAD M. AL-QATTAN, FRCSC

This article presents a detailed review of the history, etiology, assessment protocols, and current treatment for children who suffer an obstetric birth palsy. In addition, new issues facing surgeons who deal with these patients and their families are discussed. Copyright © 2003 by the American Society for Surgery of the Hand he credit for the first clinical description of obstetric palsy goes to Smellie1 in 1764. The term obstetric palsy was provided by Duchenne2 of Boulogne in 1872 in his book in which he describes 4 cases of upper brachial plexus birth palsy. The classic description by Erb3 in 1874 concerned the upper brachial plexus paralysis in adults and he defined “Erb’s point” in the neck (the spot where the fifth and sixth cervical roots unite). Currently, the terms Erb’s palsy and Erb’s-Duchenne’s Palsy indicates upper brachial plexus injury involving the C5, C6, and C7 roots. Klumpke4 was the first female intern in Paris and she explained in 1885 the Horner’s sign in brachial plexus lesions associated with avulsion of the T1 root. Klumpke later married Dejerine and therefore isolated lower plexus palsy (involvement of the C8-T1 roots) also is called the Dejerine-Klumpke paralysis.

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ESTABLISHING A MULTIDISCIPLINARY BIRTH PALSY CLINIC he first step to be performed in managing birth palsy cases is to establish a team led by the reconstructive surgeon performing the primary surgery (a plastic surgeon in our center), a neonatologist (who manages associated birth injuries such as asphyxia), an obstetrician (who helps gather information about the delivery and the incidence of the injury), an orthopedic surgeon, an occupational therapist, a physiotherapist, and a psychiatrist. Over the past 8 years, our clinic has assessed over 450 cases of birth palsy.5

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CLASSIFICATION OF THE TYPES OF BIRTH PALSY AND THE PATHOPHYSIOLOGIC FORCES INVOLVED

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From the Division of Plastic Surgery,