CONDITIONS TREATED

Birth brachial plexus palsies (Including Erbs Palsy)

These result from difficulties during birth and are frequently associated with shoulder dystocia in manipulating the head to one side to free the shoulders, the brachial plexus (the large network of nerves that connect the spinal cord to the arm and hand) may be stretched and damaged.

A Brachial plexus lesion can be associated with a broken collar bone (clavicle) or upper arm bone (humerus) and Horner's Syndrome (eyelid droop and a smaller pupil on the same side as the weak arm). Birth brachial plexus injuries are classified according to severity:

Group 1. There is a paralysis of the shoulder muscles, deltoid, supra and infraspinatus and of the biceps. This implies a lesion of C5 and C6 only. Complete recovery is seen in 90% of the cases.
Group 2. The C7 nerve root is affected in addition to C5 an C6 and this results in a lack of wrist extension as well as shoulder and elbow impairment. Full recovery still occurs in about 70% of these children but the whole process is much slower than in the first group.
Group 3. This is a complete brachial plexus lesion with all nerves involved and it is obviously a more severe lesion. At birth the palsy of shoulder, elbow, wrist and hand is complete. Less than 50% of these children show good functional recovery.
Group 4. This is a complete brachial plexus lesion with an associated Horner’s syndrome. Only few children have good spontaneous functional recovery.

Whether to operate on the nerves or not is decided following clinical examination and neurophysiological studies (EMGs). An initial assessment by the surgeon is recommended at one month of age not only to determine requirement for surgery but also to direct the rehabilitation process.

Of major importance in the treatment of these children is the risk of long term secondary deformities such as shoulder subluxation/dislocation and the correction of lack of function by means of muscular transfers. In our Unit we have been working in the last five years on new surgical procedures to correct the shoulder deformity and maximise function as the child grows.