KING ABDULAZIZ UNIVERSITY KING FAHAD GENERAL HOSPITAL JEDDAH KSA Obstetric brachial plexus palsy Pediatric brachial plexus palsy Adults brachial plexus palsy Obstetric versus birth ID: 953496
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BASSAM MJ ADDAS, FRCSC. KING ABDULAZIZ UNIVERSITY, KING FAHAD GENERAL
HOSPITAL. JEDDAH, KSA ï¨ Obstetric brachial plexus palsy ï¨ Pediatric
brachial plexus palsy ï¨ Adults brachial plexus palsy ï¨ Obstetric v
ersus birth palsy ï¨ Obstetric versus congenital palsy Not all birth p
alsies are Obstetric but the majority are â¦â¦ .. 1. Complete brachi
al plexus injury 2. Duchenne - Erb palsy 3. Upper - middle trunk brachi
al plexus injury 4. Klumpke - Dejerine palsy 5 . Bilateral brachial p
lexus palsy Cephalopelvic disproportion, shoulder dystocia, forceps de
livery !!! Maternal diabetes Breech presentation, can be bilateral Pre
vious child with plexus injury Fetal anomalies, cervical ribs, other â
¦â¦ . The practice of midwifery !!!!!!! Largely unknown Retrospective
studies Small number of patients, lots of loss of follow up Referral bi
as A surgical series will differ significantly when compared to a reha
bilitation or medical series ï¨ Overall it is good for upper trunk, no
so for total palsy ï¨ External rotation of the shoulder and supinat
ion usually recovers late. ï¨ Sensory recovery is better than motor re
covery particularly in the hand ï¨ Return of motor function continue
to recover up to 2 ½ years and the sensory function up to 3 years.
ï¨ Not right that all recovers ï¨ Not right that nothing can be done
ï¨ Clinical diagnosis ï¨ Role of EMG ï¨ Role of MRI ï¨ Avulsion in
adults ï¨ Avulsion and sometimes rupture in children ï¨ Can improve d
ramatically and even disappear, so ask about even if you do not see it
ï¨ No complaints usually Attempt to improve the accuracy of preoperat
ive diagnosis. Absence of re - innervation in 3 months is indicativ
e of avulsion injury Near normal EMG can be found in patients with co
mplete OBPI In patients with OBPI denervation occurs and disappears mu
ch earlier, can be found as early as 4 days and disappear by 4 mon
ths Short distance and small nerves are two possible explanations The
process may start as early as 1 - 2 days and disappears as early as
10 - 60 days The majority of centres do not rely on EMG in making a
preoperative diagnosis * clinical exam * preoperative imaging - mye
logram +CT scan - MRI CT myelogram is more sensitive Wait for a mont
h before getting MRI ï¨ Our main objective in OPBI is the hand. ï¨
Proximal muscles have a better chance most of the time. ï¨ The hand r
econstructive procedures are not as satisfactory as the shoulder and e
lbow ï¨ Upper trunk ï¡ Grade IV and V 52 % ( 80 %) ï¡ Grade III
40 % ( 60 %) ï¡ Grade I and II 8 % ï¨ Upper and middle
trunk ï¡ Grade IV and V 36 % ( 61 %) ï¡ Grade III
46 % ï¡ Grade I and II 18 % ï¨ Total OBPI ï¡ Second
ary reconstructive procedures are always needed. ï¡ Elbow flexion can