TREATMENT OF OBSTETRIC BRACHIAL PARALYSIS WITH A REPORT OF FIFTY CASES

¹ The First Surgical Division of Fordham Hospital, New York.

1. Obstetric brachial paralysis should be treated by the orthopaedic surgeon as early as possible.

2. If treated early and properly, one may expect in the mild cases a good recovery in three or four months.

3. The more severe cases will require about six or seven months for a complete recovery.

4. Nerve operations are indicated if no improvement results in four months.

5. If sufficient improvement is noticed in four months, one may wait for four months more.

6. The shoulder should be put immediately in a splint or brace to prevent stretching of the paralyzed muscles and contraction of the unopposed muscles.

7. The support must be kept up for a very long time, for about eight to nine months, as deformities may occur.

8. Adhesions may occur due to slight injuries of the capsule, but these can be prevented.

9. The only deformity that it is hard to prevent is the pronation of the forearm.

10. The posterior dislocation is a sequel to the unbalanced paralysis of the shoulder muscles and may be prevented in most cases by proper orthopaedic methods.

11. The obstetricians can prevent the condition in many cases by proper management of the shoulder.

12. Taylor's procedure seems to be the most suitable for the nerve operations.

13. After-treatment must be carefully carried out after Taylor's operation.

14. Sever's operation is the best for correction of the shoulder deformities.

15. Hooking of the coracoid process should be corrected by a subperiosteal resection.

16. Pronation should be corrected by a tenotomy of the pronator radiiteres. One may also transplant that muscle to use it as a supinator.

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