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Lesão do plexo braquial no nascimento

Última revisão: 17 Aug 2025
Última atualização: 19 Mar 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • paralisia de um braço
  • movimento reduzido observado de um braço
  • postura anormal do braço
Detalhes completos

Outros fatores diagnósticos

  • crepitação da clavícula ou úmero
  • síndrome de Horner
  • taquipneia, desconforto respiratório, dificuldades de alimentação, retardo do crescimento pôndero-estatural
  • falta de total amplitude de movimentos passivos
  • hiper-reflexia, reflexos primitivos persistentes, tônus muscular anormal ou postura corporal anormal
Detalhes completos

Fatores de risco

  • distocia do ombro
  • tamanho fetal grande (>4000 g)
  • diabetes materno (principalmente do tipo 1) ou diabetes mellitus gestacional
  • obesidade materna
  • apresentação de nádegas
  • segunda fase do trabalho de parto atípica
  • parto assistido
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • diagnóstico clínico
  • radiografia torácica e do membro superior afetado
Detalhes completos

Investigações a serem consideradas

  • ultrassonografia do ombro
  • RNM/mielografia por RNM
  • TC/mielotomografia
  • eletromiografia (EMG)/estudos da condução nervosa
Detalhes completos

Novos exames

  • ressonância nuclear magnética (RNM) tridimensional com densidade de prótons para avaliar o plexo braquial
  • avaliação por RNM volumétrica e EMG dos músculos do manguito rotador
  • avaliação ultrassonográfica do plexo braquial

Algoritmo de tratamento

AGUDA

neonatos e lactentes

CONTÍNUA

após o tratamento inicial

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

Disclosures

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

Disclosures

SAR declares that she has no competing interests.

Peer reviewers

Whitney E. Muhlestein, MD

Peripheral Nerve Fellow

University of Michigan

Ann Arbor

MI

Disclosures

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

Disclosures

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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

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

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. Abstract

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

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Lesão do plexo braquial no nascimento images
  • Differentials

    • Fratura da clavícula ou úmero
    • Artrite séptica do ombro ou osteomielite umeral proximal
    • Tumor da medula espinhal ou plexo braquial
    More Differentials
  • Guidelines

    • The evaluation and management of neonatal brachial plexus palsy
    • ACOG neonatal brachial plexus palsy: task force report
    More Guidelines
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