Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- paralysis of an arm
- observed decreased motion of an arm
- abnormal posture of the arm
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
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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- clinical diagnosis
- x-ray of chest and affected upper extremity
Investigações a serem consideradas
- ultrasound scan of the shoulder
- MRI/MRI myelogram
- CT/CT myelogram
- EMG/nerve conduction studies
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
newborns and infants
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
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.
Diferenciales
- Clavicle or humeral fracture
- Septic arthritis of the shoulder or proximal humeral osteomyelitis
- Spinal cord or brachial plexus tumor
Más DiferencialesGuías de práctica clínica
- ACOG neonatal brachial plexus palsy: task force report
Más Guías de práctica clínicaInicie sesión o suscríbase para acceder a todo el BMJ Best Practice
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