小结
定义
病史和体格检查
关键诊断因素
- 单侧手臂麻痹
- 观察到某一手臂活动度下降
- 手臂姿势异常
其他诊断因素
- 锁骨或肱骨劈啪声
- Horner 综合征
- 呼吸急促、呼吸窘迫、喂食困难、生长迟缓
- 被动运动关节活动度降低
- 反射亢进、持续性原始反射、肌张力异常或身体姿势异常
危险因素
- 肩难产
- 婴儿体型偏大（>4000g）
- 孕妇糖尿病（尤其是1型）或妊娠糖尿病
- 产妇肥胖
- 臀先露
- 第二产程异常
- 接受辅助的分娩
诊断性检查
首要检查
- 临床诊断
- 胸部和患侧上肢 X 线检查
需考虑的检查
- 肩部超声扫描
- MRI/MRI 脊髓造影
- CT/CT 脊髓造影
- EMG /神经传导检查
新兴检查
- 用于评估臂丛神经的三维质子密度 MRI
- 肩袖肌肉的容积 MRI 与 EMG 评估
- 臂丛神经的超声评估
治疗流程
新生儿及婴幼儿
初始治疗之后
撰稿人
作者
Mark J. Adamczyk, MD
Co-Director
Brachial Plexus Treatment Center
Vice-Chairman
Department of Pediatric Orthopedic Surgery
Akron Children's Hospital
Akron
OH
利益声明
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
利益声明
SAR declares that she has no competing interests.
同行评议者
Lynda J-S Yang, MD, PhD
Professor
Neurological Surgery
University of Michigan
Ann Arbor
MI
利益声明
LJSY is an author of several references cited in this topic.
Whitney E. Muhlestein, MD
Peripheral Nerve Fellow
University of Michigan
Ann Arbor
MI
利益声明
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
利益声明
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.
鉴别诊断
- 锁骨或肱骨骨折
- 肩膀脓毒性关节炎或近端肱骨骨髓炎
- 脊髓或臂丛肿瘤
更多 鉴别诊断指南
- 新生儿臂丛神经麻痹的评估和管理
- ACOG 新生儿臂丛神经麻痹：工作组报告
更多 指南
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