Neonatal brachial plexus injuries

Purpose of review: Neonatal brachial plexus palsy results from damage to the infant's brachial plexus that most commonly occurs during delivery. The mechanism of injury is traction to the plexus during labor. Nerve damage sustained with these injuries ranges from axonotmesis to complete avulsion of nerve roots from the spinal cord. Although many children who are affected recover excellent function, a significant proportion with more severe plexus injuries are left with permanently impaired function. Recent findings: Controversy exists in relation to many areas concerning the treatment of children with neonatal brachial plexus palsy. Issues such as which children are best served by microsurgical intervention, what procedures are appropriate, and the timing of microsurgical nerve repair are discussed. Recently, attention has been focused once again on the development of early shoulder joint contractures causing posterior subluxation or dislocation of the shoulder joint. Summary: This review aims to discuss these areas of controversy. It deals with microsurgical intervention, the early diagnosis of posterior shoulder joint subluxation using ultrasonography, and the treatment of this disorder. It also discusses secondary reconstructive procedures that are frequently necessary in this patient population.