Affiliations: Department of Orthopaedic Surgery, University of
Michigan Hospitals, Ann Arbor, MI, USA
Note: [] Corresponding author: Kelly Vander Have, MD., Assistant
Professor, Pediatric Orthopaedic Service, UM Department of Orthopaedic Surgery,
1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA. Tel.: +1 734 615 3599;
Fax: +1 734 642 3291; E-mail: klvander@umich.edu
Abstract: Brachial plexus birth palsy occurs at a rate of 1/1000–4/1000
live births despite advances in prenatal and obstetric care. The majority of
children recover spontaneously, however some are left with permanent neurologic
deficit. Shoulder pathology results from muscle imbalance created by pairing of
weak or paralyzed muscles with unaffected muscle groups around the shoulder.
This imbalance results in soft tissue contracture and can cause progressive
glenohumeral joint morphological changes. Contractures of internal rotation are
most common and may be a source of disability for the child. Treatment of the
infant with brachial plexus palsy is initially centered around therapy and
prevention of contracture. Surgical intervention can improve global shoulder
function, and is reserved for patients who develop functionally limiting
contractures, glenohumeral joint morphological changes, or findings of
instability. A thorough physical examination, appropriate imaging, and
assessment of the goals and expectations of the family are warranted prior to
proceeding with any treatment course. The progressive and functionally limiting
course of the shoulder sequelae in brachial plexus palsy emphasizes the need
for early recognition and appropriate management. The purpose of this
manuscript is to review orthopedic evaluation and management of neonatal
brachial plexus palsy (NBPP) to promote early recognition and prompt
referral.
