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The Journal of Bone and Joint Surgery 81:1612-27 (1999)
© 1999 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Tendon Transfers About the Shoulder and Elbow in Obstetrical Brachial Plexus Palsy*{dagger}

JAMES B. BENNETT, M.D.{ddagger}, HOUSTON, TEXAS and CHRISTOPHER H. ALLAN, M.D.§, SEATTLE, WASHINGTON

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons


   Introduction
 
Obstetrical or birth palsy of the brachial plexus occurs in as many as one in 250 births30,32. Predisposing factors include high birth weight, prolonged labor, breech presentation, and shoulder dystocia. The actual lesion is produced by traction on the neural elements—for example, stretching of the brachial plexus with forced lateral flexion of the head and neck. Most of these injuries resolve without operative intervention. For patients who are more severely affected, however, a variety of procedures are available (Table I). The treatment algorithm to maximize each child's long-term functional recovery is continuously evolving (Table II).


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  		TABLE I OPTIONS FOR TENDON RELEASE, TENDON OR MUSCLE TRANSFER, AND OSSEOUS PROCEDURES BY SITE

 

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  		TABLE II TIMING OF OPERATIVE PROCEDURES IN PATIENTS WHO HAVE OBSTETRICAL BRACHIAL PLEXUS PALSY

 
In the earliest phase of treatment, exploration, neurolysis, and operative repair or reconstruction of the injured brachial plexus may be undertaken. . . . [Full Text of this Article]


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