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Brachial plexus birth injury

Última revisão: 14 Aug 2025
Última atualização: 19 Mar 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • paralysis of an arm
  • observed decreased motion of an arm
  • abnormal posture of the arm
Detalhes completos

Outros fatores diagnósticos

  • crepitance of clavicle or humerus
  • Horner syndrome
  • tachypnea, respiratory distress, feeding difficulties, failure to thrive
  • lack of full range of passive movement
  • hyperreflexia, persistent primitive reflexes, abnormal muscle tone, or abnormal body posture
Detalhes completos

Fatores de risco

  • shoulder dystocia
  • large fetal size (>4000 g)
  • maternal diabetes (especially type 1) or gestational diabetes mellitus
  • maternal obesity
  • breech presentation
  • atypical second phase of labor
  • assisted delivery
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • clinical diagnosis
  • x-ray of chest and affected upper extremity
Detalhes completos

Investigações a serem consideradas

  • ultrasound scan of the shoulder
  • MRI/MRI myelogram
  • CT/CT myelogram
  • EMG/nerve conduction studies
Detalhes completos

Novos exames

  • three-dimensional proton-density MRI to assess the brachial plexus
  • volumetric MRI and EMG assessment of rotator cuff muscles
  • ultrasound evaluation of the brachial plexus

Algoritmo de tratamento

AGUDA

newborns and infants

CONTÍNUA

following initial treatment

Colaboradores

Autores

Mark J. Adamczyk, MD

Co-Director

Brachial Plexus Treatment Center

Vice-Chairman

Department of Pediatric Orthopedic Surgery

Akron Children's Hospital

Akron

OH

Declarações

MJA declares that he has no competing interests.

Stephanie A. Russo, MD, PhD

Co-Director

Brachial Plexus Treatment Center

Pediatric Hand and Peripheral Nerve Surgery

Akron Children’s Hospital

Akron

OH

Declarações

SAR declares that she has no competing interests.

Revisores

Whitney E. Muhlestein, MD

Peripheral Nerve Fellow

University of Michigan

Ann Arbor

MI

Divulgaciones

WEM declares that she has no competing interests.

Tim Hems, MA, DM, FRCS(Eng), FRCSEd(Orth)

Consultant Hand and Orthopaedic Surgeon

Queen Elizabeth University Hospital

Glasgow

UK

Divulgaciones

TH declares that he has written a number of publications over the last few years which highlight the lack of evidence that nerve repair surgery improves outcome in brachial plexus birth palsy.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

American College of Obstetricians and Gynecologists. Neonatal brachial plexus injury. 2014 [internet publication].Texto completo

Royal College of Obstetricians and Gynaecologists. Shoulder dystocia: green-top guideline no 42. March 2012 [internet publication].Texto completo

Smith BW, Daunter AK, Yang LJ, et al. An update on the management of neonatal brachial plexus palsy-replacing old paradigms: a review. JAMA Pediatr. 2018 Jun 1;172(6):585-91. Resumen

Vuillermin C, Bauer AS. Boston Children's Hospital approach to brachial plexus birth palsy. J Pediatr Orthop B. 2016 Jul;25(4):296-304. Resumen

Pondaag W, Malessy MJA. Evidence that nerve surgery improves functional outcome for obstetric brachial plexus injury. J Hand Surg Eur Vol. 2021 Mar;46(3):229-36.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Brachial plexus birth injury images
  • Diferenciales

    • Clavicle or humeral fracture
    • Septic arthritis of the shoulder or proximal humeral osteomyelitis
    • Spinal cord or brachial plexus tumor
    Más Diferenciales
  • Guías de práctica clínica

    • ACOG neonatal brachial plexus palsy: task force report
    Más Guías de práctica clínica
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