Резюме
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- paralysis of an arm
- observed decreased motion of an arm
- abnormal posture of the arm
Другие диагностические факторы
- 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
Факторы риска
- 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
Диагностические исследования
Исследования, которые показаны в первую очередь
- clinical diagnosis
- x-ray of chest and affected upper extremity
Исследования, проведение которых нужно рассмотреть
- ultrasound scan of the shoulder
- MRI/MRI myelogram
- CT/CT myelogram
- EMG/nerve conduction studies
Неотложные исследования
- 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
Алгоритм лечения
newborns and infants
following initial treatment
Составители
Авторы
Mark J. Adamczyk, MD
Co-Director
Brachial Plexus Treatment Center
Vice-Chairman
Department of Pediatric Orthopedic Surgery
Akron Children's Hospital
Akron
OH
Раскрытие информации
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
Раскрытие информации
SAR declares that she has no competing interests.
Рецензенты
Whitney E. Muhlestein, MD
Peripheral Nerve Fellow
University of Michigan
Ann Arbor
MI
Раскрытие информации
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
Раскрытие информации
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.
Список литературы
Основные статьи
American College of Obstetricians and Gynecologists. Neonatal brachial plexus injury. 2014 [internet publication].Полный текст
Royal College of Obstetricians and Gynaecologists. Shoulder dystocia: green-top guideline no 42. March 2012 [internet publication].Полный текст
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. Аннотация
Vuillermin C, Bauer AS. Boston Children's Hospital approach to brachial plexus birth palsy. J Pediatr Orthop B. 2016 Jul;25(4):296-304. Аннотация
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.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Clavicle or humeral fracture
- Septic arthritis of the shoulder or proximal humeral osteomyelitis
- Spinal cord or brachial plexus tumor
Больше ОтличияРекомендации
- ACOG neonatal brachial plexus palsy: task force report
Больше Рекомендации
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