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Birth-Related (Obstetrical) Brachial Plexus Injuries

Background

The term birth-related brachial plexus palsy (BRBPP) refers to injury noted in the perinatal period to all or a portion of the brachial plexus.
The term obstetrical brachial plexus palsy (OBPP) has also been used but has negative implications; accordingly, other terms, such as birth-related brachial plexus injury (BRBPI), are often preferred, particularly in the United States.
 Injuries associated with the upper brachial plexus are classically termed Erb palsies, and those associated with the lower plexus are traditionally termed Klumpke palsies.

In 1768, Smellie described bilateral arm paralysis in a newborn.
 In 1872, Guillaume Duchenne coined the term obstetrical paralysis.
 Erb described C5-C6 paralysis in 1874,
 and in 1885, Klumpke described paralysis of the lower plexus. The first description of operative management for obstetrical brachial plexus lesions was reported in 1903.
 Poor outcomes and reports by Sever recommending nonoperative management
 led to little interest in surgical management of OBPP until the microsurgical era brought renewed interest. In the 1980s, Gilbert popularized the most common indication for surgical reconstruction of obstetrical brachial plexus injuries.

Management of children with BRBPP remains challenging. Technological and surgical advancements have improved patient outcomes, but room for improvement remains. Previous controversy regarding surgical timing has been replaced with evidenced-based results. Outcomes analysis would benefit from a universal outcome measurement tool to allow comparison among institutions. Given the small number of patients who require surgical management, meta-analyses would allow better trend analysis.

Continued experience with direct nerve transfers may eventually minimize interpositional grafting procedures. Basic science research continues for methods of enhancing peripheral nerve regeneration and target muscle protection. The future of management of patients with OBPP continues to benefit from a multidisciplinary approach for delineating optimal treatment methods.

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