الفهرس Only 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
Brachial plexus birth palsy has an incidence of 0.38 to1.56 per 1000 live birth. The difference in incidence may depend on the type of obstetric care and the average birth weight of infants in different geographic regions. Perinatal risk factors include macrosomnia, multiparous pregnancies, prolonged labor, breech delivery, and assisted (vacuum or forceps) and difficult deliveries. Delivery by cesarean section does not exclude the possibility of birth trauma. Most commonly, a brachial plexus birth palsy involves the upper trunk (C5-C6) -the classic Erb’s palsy-, potentially in combination with an injury to C7, less often, the entire plexus (C5-T1) is injured. On extremely rare occasions the lower trunk (C8-T1) - klumpke’s paralysis- can be most significantly involved. Most infants with brachial plexus birth palsy recover within the first few weeks of life with no functional deficit, some are lift with persistent paresis of the upper extremity including shoulder, elbow, and the hand. Treatment of brachial plexus injury is primary- nerve grafting, nerve transfer- or secondary surgery including contracture release, muscle transfer, osteotomies, or arthorodersis. Brachial plexus injury lead to muscular and periarticulat tightness, failure of neuromuscular recovery which can produce several deformities including; adduction internal rotation deformity with or without joint deformities- due to external rotator weakness-, external rotation deformity-infraspinatus and teres minor contracture-, pure abduction, winging of the scapula, or flail joint. Invasive radiographic studies with myelography, combined myelography and computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans have been used to diagnose brachial plexus injuries and to distinguish between avulsion and extraforminal rupture. Myelography had an 84% true-positive rate with 4% false–positive and 12% false-negative rates. The addition of CT with myelography increase true positive rate to (94%). MRI had a true-positive rate similar to that of myelo-CT studies, but also allow extraforaminal evaluation of the plexus. High spino-echo MRI increase resolution of MRI analysis. Electrodiagnostic studies with electromyography (EMG), sensory nerve action potentials (SNAP), and somatosensory evoked potentials (SSEP) have also been used in an attempt to improve the diagnostic accuracy of the severity of the neural lesion. There are many methods which can used to evaluate the deformities, including:
- Assessment of the motor function by different scoring system.
- X-ray for bone and joints.
- Computed tomography for children older than 5 years.
- Magnetic resonance imaging for children younger than 5 years.
- Arthroghraphy.
- Ultrasound.
- Arthroscopy, in shoulder affection.