Short-term outcome of physiotherpy and surgical treatment of obstetrical brachial plexus palsy
DOI:
https://doi.org/10.3329/bsmmuj.v18i2.75605Keywords:
obstetric brachial plexus palsy, rehabilitation, physiotherapy, surgeryAbstract
Background: Birth injury to the brachial plexus is referred to as obstetric brachial plexus palsy (OBPP). This study aimed to evaluate the clinical presentation and treatment outcomes of OBPP.
Methods: This study was conducted in the Orthopaedic and Neonatology Department at Bangabandhu Sheikh Mujib Medical University. Infants with OBPP who presented within six months were included and initially treated with physiotherapy for up to six months. There were incomplete (neuropraxia and axonotmesis) and complete (neurotmesis) injuries. If biceps power was recovered of birth (≥M3), therapy was continued for up to 18 months. If there was no significant improvement (≤M2), surgery was performed. The final outcome was assessed after 18 months using the Mallet score, the Raimondi score, and the Medical Research Council muscle grading scale.
Results: Out of 200 OBPP cases, 90% were enrolled through the outpatient department. One-fourth were identified during the neonatal period. The majority (96%) were born via vaginal delivery, with shoulder dystocia occurring in 68% of cases. Instrumental deliveries resulted in more severe injuries. Females and right-sided involvement were predominant. The overall satisfactory result with physiotherapy was observed in 65%, cases, whereas after surgery, it improved to 80%. However, when considering the upper trunk only, it approached 85% with physiotherapy and 98% after surgery (Mallet score >15, Medical Research Council grade ≥ 4, Raimondi score ≥2). For lower trunk and panplexus cases, satisfactory outcomes following physiotherapy and surgery were 41%.
Conclusion: Treatment initiated within six months have ensured nearly full recovery of most upper trunk and incomplete OBPP cases, but outcomes of severely affected lower trunk and panpalsy cases was poor.
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References
Yamben MAN, Alexandre M, Kennedy M, Obama SAM, Etouckey EN, Chunteng TN, Tsiagadigui JGT, Franklin MM, Awa M and Farikou I. Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents. Open Journal of Orthopedics.2022; 12:212-224. doi: https//doi.org/10.4236/ojo.2022.124020
Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am. 2010 Feb;35(2):322-331. doi: https//doi.org/10.1016/j.jhsa.2009.11.026
Thatte MR, Mehta R. Obstetric brachial plexus injury. Indian J Plast Surg. 2011 Sep;44(3):380-389. doi: https//doi.org/10.4103/0970-0358.90805
Waters PM, Bae DS. Pediatric Hand and Upper Limb Surgery: A Practical Guide (1st ed.). Philadelphia: Lippincott Williams & Wilkins (LWW). 2012:181-218. ISBN:978-1-58-255870-7. https://www.amazon.com/Pediatric-Hand-Upper-Limb-Surgery/dp/1582558701
Coroneos CJ, Voineskos SH, Christakis MK, Thoma A, Bain JR, Brouwers MC; Canadian OBPI Working Group. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline. BMJ Open. 2017 Jan 27;7(1):e014141. doi: https//doi.org/10.1136/bmjopen-2016-014141
Waters PM. Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am. 1999 May;81(5):649-659. doi: https://doi.org/10.2106/00004623-199905000-00006
Swift, Amy. A brief overview of obstetric brachial plexus palsy. British Journal of Midwifery. 2023;31(10): 576-583. doi: https://doi.org/10.12968/bjom.2023.31.10.576
Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L, Mitra DK (2016) Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration. PLoS ONE 11(1): e0146161. doi: https://doi.org/10.1371/journal.pone.0146161
Swift A. A brief overview of obstetric brachial plexus palsy. British Journal of Midwifery. 2023;31(10):576-583. doi: https://doi.org/10.12968/bjom.2023.31.10.576
Rakan S. Al-Essa, Rakan M. Al-Khilaiwi, Ali A. Al-Qahtani, Abdullah M. Al-Thunayan and Mohammad M. Al-Qattan. Obstetric brachial plexus injury. Saudi Medical Journal. July 2017, 38 (7) 721-726. doi: https://doi.org/10.15537/smj.2017.7.17615
Hems T, Todd-Hems A. Obstetric brachial plexus injury in Scotland: incidence over 16 years. J Hand Surg Eur Vol. 2023 Jul;48(7):668-669. doi: https://doi.org/10.1177/17531934231166824
Bahm J. Re: Pondaag W and Malessy MJA. Evidence that nerve surgery improves functional outcome for obstetric brachial plexus injury. J Hand Surg Eur. 2021, 46: 229-36 Re: Hems T. Commentary on 'Evidence that nerve surgery improves functional outcome for obstetric brachial plexus injury'. J Hand Surg Eur. 2021, 46: 237-8. J Hand Surg Eur Vol. 2022 Feb;47(2):222-224. doi: https://doi.org/10.1177/17531934211021729
Spires MC, Leonard JA, Wolf J, RNCST. The role of electrodiagnosis in infants with brachial plexus palsies. In: In Chung KC, Yang LJ-S, McGillicuddy JE. Practical management of pediatric and adult brachial plexus palsies. 1st edition. Edinburgh: Elsevier Inc;2012. P.68-73 & 80-84. ISBN-13: 978-1-4377-0575-1, PN:9996076296. doi: https://doi.org/10.1016/B978-1-4377-0575-1.00007-1
Al-Qattan MM, El-Sayed AA, Al-Zahrani AY, Al-Mutairi SA, Al-Harbi MS, Al-Mutairi AM, Al-Kahtani FS. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol. 2009 Dec;34(6):788-791. doi: https://doi.org/10.1177/1753193409348185
Waters, PM. Update on management of pediatric brachial plexus palsy. J Pediatr Orthop B. 2005 July;14(4):233-244. doi: https://doi.org/10.1097/01202412-200507000-00001
Sebastin SJ, Chung KC. Pathogenesis and management of deformities of the elbow, wrist, and hand in late neonatal brachial plexus palsy. J Pediatr Rehabil Med. 2011;4(2):119-130. doi: https://doi.org/10.3233/PRM-2011-0169
Inglis SR, Feier N, Chetiyaar JB, Naylor MH, Sumersille M, Cervellione KL, Predanic M. Effects of shoulder dystocia training on the incidence of brachial plexus injury. Am J Obstet Gynecol. 2011 Apr;204(4):322-326. doi: https://doi.org/10.1016/j.ajog.2011.01.027
Haerle M, Gilbert A. Management of complete obstetric brachial plexus lesions. J Pediatr Orthop. 2004 Mar-Apr;24(2):194-200. doi: https://doi.org/10.1097/00004694-200403000-000
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Copyright (c) 2025 Krishna Priya Das, Rumpa Mani Chowdhury, Sk. Murad Ahmed, Md. Moniruzaman, Mohammod Shahidullah
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