Summary
Definition
History and exam
Key diagnostic factors
- paralisia de um braço
- movimento reduzido observado de um braço
- postura anormal do braço
Other diagnostic factors
- 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
Risk factors
- 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
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
- radiografia torácica e do membro superior afetado
Investigations to consider
- ultrassonografia do ombro
- RNM/mielografia por RNM
- TC/mielotomografia
- eletromiografia (EMG)/estudos da condução nervosa
Emerging tests
- 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
Treatment algorithm
neonatos e lactentes
após o tratamento inicial
Contributors
Authors
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
Declarações
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
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.
Differentials
- Fratura da clavícula ou úmero
- Artrite séptica do ombro ou osteomielite umeral proximal
- Tumor da medula espinhal ou plexo braquial
More DifferentialsGuidelines
- The evaluation and management of neonatal brachial plexus palsy
- ACOG neonatal brachial plexus palsy: task force report
More Guidelines
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