Simplifying Obstetrical Brachial Plexus injury for the undergraduate & post-post-graduate students.

3. Obstetrical Brachial Plexus
Palsy(OBPI)
Dr. Md. Ashiqur Rahman
MBBS, MS(Ortho)

4. Due to excessive traction of
the Brachial plexus during
child birth.

5. 1 in 2300 live birth in UK

7. 3 patterns:
1.Upper root(C5,C6) injury(Erb’s
Palsy):
- Over weight babies with
shoulder dystocia

8. ERB’S PALSY

9. 2. Lower root(C8,T1)
injury(Klumpke’s Palsy):
- Usually after breech delivery of
smaller babies

10. KLUMPKE’S PALSY

11. 3. Total plexus injury(C5-T1)

12. Total plexus injury

13. NARAKAS CLASSIFICATION

14. ERB’S PALSY
 Suprascapular nerve(C5,C6):
- Supraspinatus: Initiate abduction
- Infraspinatus: Primary ER
 Axillary nerve(C5,C6):
- Deltoid: Chief abductor of the shoulder also
responsible for ER

15. ERB’S PALSY
 Musculocutaneous nerve(C5,C6,C7):
- Biceps Brachii: Elbow flexion
- Brachialis: Elbow flexion

16. ERB’S PALSY
 Shoulder: Adducted & IR
 Elbow: Extended
 Forearm: Pronated
Fingers: Flexed

17. KLUMPKE’S PALSY
 Ulnar nerve(C8,T1):
- Intricsic Muscles of hand:
MP flexion & IP extension: Clawing

18. KLUMPKE’S PALSY
 Forearm : Supinated
 Elbow: Flexed
 Hand: Clawing

19. Total plexus injury
 Arm: Flail & Pale
 All finger muscles:
- Paralyzed
 Vasomotor impairment
 Unilateral Horner’s syndrome

20. Horner’s Syndrome

21. Investigations
 EMG
 Xray Chest
 MRI
 USG

22. Treatment
1.Observation:
- Over next few weeks
- Physiotherapy
- Keep the joint mobile

23. One of the several things may happen:
 Paralysis may recover completely:
- 60-70%
- Reliable indication is return of Biceps activity

24.  Paralysis may improve:
- Total lesion may partially resolve
 Paralysis may remain unaltered:
- Complete lesion with Horner’s syndrome

25. Surgical Treatment
Indication:
- No shoulder activity or no Biceps
recovery by 03 months.
- Narakas group 3 & 4 lesion
- Presence of Horner’s syndrome

26. Surgical treatment options
 Neurolysis
Resection & anastomosis
 Nerve grafting using Sural nerve