Course Description:

A BPBI involves transient or permanent damage to the brachial plexus of a fetus or newborn during labor, with or without delivery assistance. Many risk factors for BPBI have been reported, ranging from maternal and infant characteristics to obstetric maneuvers. The mechanism of injury is believed to involve either a compression force or a traction force applied to the brachial plexus. BPBIs are classified according to the nerve roots involved (upper, lower, or all of the brachial plexus) and result in paralysis of the muscles innervated by those nerve roots as well as sensory deficits in associated cutaneous distributions. Upper plexus injuries result in loss of shoulder and elbow function with a “waiter's tip” deformity. In contrast, a lower BPBI results in a “claw hand” deformity due to paresis of the hand. An injury of the entire brachial plexus results in total paralysis of the involved upper extremity. Recovery estimates vary depending on the severity of the nerve injury. Most infants have spontaneous recovery in the first 6 to 8 weeks of life. For patients with permanent damage, surgery in conjunction with postoperative rehabilitation is performed to improve range of motion (ROM), muscle strength, sensation, and joint proprioception and to minimize joint contracture of the upper extremity.