Current Approach to Obstetric Brachial Plexus Palsy

Obstetrical brachial plexus palsy (BPP) is defined a flaccid paresis caused by damage of brachial plexus before or during delivery. Beyond 80-90% of patients may develop spontaneous remission; in 5-25% may develop lifelong disability. Recovery in 2 weeks period is an indicator of good prognosis. Although magnetic resonance imagination is often used for screening method, ultrasonography is detected as a rapid, visible, reliable method in recent years. Electrodiagnostic studies provide us for disease origin, severity, prognosis and anatomic localization. In diagnosis and clinical evaluation there have been lack of specific scales and methods for BPP patients. Treatment program consume of conservative (physical therapy, occupational therapy and botulismus toxin A) therapy and surgery. In surgery: neurolysis, nerve graft reconstructions and osteotomies could be done. Still, the timing and indication of surgery is controversial. Recently there is a tendency for doing surgery in 3-6 months period in absent of remission signs. On the other hand with delayed surgery there have seen better results in some new studies so a common opinion arised for delaying surgery not to skip patients developing spontaneous remission.

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