Obstretical brachial plexus palsy

In this condition the parents will observe that the new born child is not moving a part of upper limb or whole of upper limb. The incidence is around 0.15 and 3 per 1000 live births.Obstetric brachial plexus injuries occur at birth due to traction injury. Fracture of clavicle and humerus should be ruled out. Although spontaneous recovery is known, there is a large subset (10-30%) which does not recover and needs primary or secondary surgical intervention It is important to get physiotherapy as soon as possible for the best outcomes and to continue with exercises at home to avoid joint contractures. Electrophysiology is recommended at 4 weeks initially to confirm the diagnosis and get a baseline reading. It can be repeated around 3-6 months of age. Surgery is usually performed around 6-9 months Indications for surgery are as follows

• Global involvement
• Failure of recovery of hand function
• a lack of antigravity biceps function at 3 month
• total palsy with Horner’s syndrome

Clinical picture of a child with obstretical brachial plexus palsy of left upper limb
13 year old child with untreated obstretical brachial plexus palsy of right upper limb showing contracture of muscles