Congenital brachial palsy
This study provided an opportunity to gather population-based data about Congenital brachial palsy. It aimed to estimate the incidence of Congenital brachial palsy, study its aetiology and provide more information about the natural history of CBP in the first year of life. The study ran from March 1998 to March 1999, when the true incidence in the UK and the Republic of Ireland was unknown.
Lead investigator
Dr G Evans-Jones
About the study
At the time of this study, congenital brachial palsy (CBP) was thought to be due to an injury at birth to part or all of the brachial plexus. However, clear evidence of injury was not present in all cases. The commonest type was Erb’s palsy. Some thought the incidence declined; however, others suggested that the incidence may have increased, possibly as the average baby birth weight has increased. The true incidence in the UK and the Republic of Ireland was unknown.
The cause was commonly thought to be due to an injury to part, or all of, the brachial plexus at birth due to either local pressure (instruments, fingers, local soft tissue swelling or haematoma) or lateral traction on the fetal head or upper limb causing stretching,
rupture or avulsion of the nerve roots of the plexus. This resulted in weakness or paralysis of the arm. Associated lesions include fractures of the clavicle and proximal humerus, shoulder dislocation, phrenic nerve palsy and Horner’s syndrome. Between 8% to 20% of cases of Erb’s palsy were reported to be bilateral, almost exclusively associated with breech extraction.
As well as breech delivery, shoulder dystocia and large fetal weight were common associations; some cases were unexplained, occurring without such factors. Full muscle recovery varied widely from as little as 13% to 80% of cases. Similarly, the onset of recovery was variable, ranging from two to fourteen weeks, and improvements may continue for up to 18 months.
Severe cases with little recovery result in a serious handicap – the function of the shoulder, elbow, forearm and wrist may be significantly impaired, affecting social, physical and educational development. Even in less severe cases, with only residual impairment of shoulder movement, for example, significant disability can result.
The present therapeutic approach was to use physiotherapy to prevent joint contracture. Although there were reports of encouraging results using microsurgical nerve grafting techniques, the indications for surgery were unclear and controversial, and the effectiveness of the techniques remained unproven. It was suggested that some infants who could have benefited from surgery were not given the opportunity for early expert assessment, being referred too late for surgery to be effective. Many reported studies are of selected cases. This study provided an opportunity to gather population-based data about this important condition.
Duration
March 1998 – March 1999
Published papers
Evans-Jones G, Kay SP, Weindling AM, Cranny G, Ward A, Bradshaw A, Hernon C. Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland. Arch Dis Child Fetal Neonatal Ed. 2003 May;88(3):F185-9. doi: 10.1136/fn.88.3.f185. PMID: 12719390; PMCID: PMC1721533.
BPSU 14th Annual report 1999-2000
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