Multimodal Management and Triple Nerve Transfer for Optimal Recovery of Shoulder Function Following Neonatal Brachial Plexus Palsy: A Case Report

Neonatal brachial plexus palsy is a complex disorder that requires evaluation of the primary nerve injury and associated sequelae. There is no standardized approach to management, and many treatment options are available. We present a case of Erb palsy with a unique multidisciplinary approach to nonsurgical and surgical management. Inherent in the case is the complexity of decision‐making, and we review the literature on treatment options and the rationale for the approach, which resulted in near normal functional recovery.

[1]  S. Wolfe,et al.  Axon Counts Yield Multiple Options for Triceps Fascicular Nerve to Axillary Nerve Transfer. , 2016, The Journal of hand surgery.

[2]  R. Tse,et al.  Glenohumeral Dysplasia Following Neonatal Brachial Plexus Palsy: Presentation and Predictive Features During Infancy. , 2015, The Journal of hand surgery.

[3]  M. Bucevska,et al.  An early shoulder repositioning program in birth-related brachial plexus injury: a pilot study of the Sup-ER protocol , 2014, Hand.

[4]  D. Zlotolow,et al.  Early functional recovery of elbow flexion and supination following median and/or ulnar nerve fascicle transfer in upper neonatal brachial plexus palsy. , 2014, The Journal of bone and joint surgery. American volume.

[5]  A. Gilbert,et al.  Triceps Innervation Pattern: Implications for Triceps Nerve to Deltoid Nerve Transfer , 2013, BioMed research international.

[6]  K. M. Chan,et al.  Distal Nerve Transfers Are Effective in Treating Patients with Upper Trunk Obstetrical Brachial Plexus Injuries: An Early Experience , 2013, Plastic and reconstructive surgery.

[7]  Rui M. V. Abreu,et al.  1-Aryl-3-[4-(thieno[3,2-d]pyrimidin-4-yloxy)phenyl]ureas as VEGFR-2 Tyrosine Kinase Inhibitors: Synthesis, Biological Evaluation, and Molecular Modelling Studies , 2013, BioMed research international.

[8]  R. Tse,et al.  Suprascapular Nerve Reconstruction in Obstetrical Brachial Plexus Palsy: Spinal Accessory Nerve Transfer versus C5 Root Grafting , 2011, Plastic and reconstructive surgery.

[9]  M. Delgado,et al.  Onabotulinum toxinA injection as an adjunct in the treatment of posterior shoulder subluxation in neonatal brachial plexus palsy. , 2010, The Journal of bone and joint surgery. American volume.

[10]  G. Borschel,et al.  Obstetrical Brachial Plexus Palsy , 2009, Plastic and reconstructive surgery.

[11]  G. Borschel,et al.  Evaluation of Elbow Flexion as a Predictor of Outcome in Obstetrical Brachial Plexus Palsy , 2007, Plastic and reconstructive surgery.

[12]  P. Carter,et al.  Intraobserver and interobserver reliability of two ultrasound measures of humeral head position in infants with neonatal brachial plexus palsy. , 2007, The Journal of bone and joint surgery. American volume.

[13]  P. Carter,et al.  Neonatal brachial plexus palsy. Outcome of absent biceps function at three months of age. , 2004, The Journal of bone and joint surgery. American volume.

[14]  P. Waters Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. , 1999, The Journal of bone and joint surgery. American volume.

[15]  S. Wolfe,et al.  Preoperative donor nerve electromyography as a predictor of nerve transfer outcomes. , 2014, The Journal of hand surgery.

[16]  J. Peltonen,et al.  Brachial plexus birth injury: US screening for glenohumeral joint instability. , 2010, Radiology.