Obstetric Brachial Plexus Palsy Associated With Breech Delivery

In Brief A review of the English literature revealed that only two birth palsy centers have specifically reviewed their experience with obstetrical palsy associated with breech delivery. The aim of this paper is to review the author's center's experience with birth palsy associated with breech delivery, compare their epidemiological and surgical findings with previous studies, and describe their management approach to this unique injury. A total of 34 limbs were studied. Erb's palsy was seen in 32 limbs and total palsy was seen in the remaining 2 limbs. The mean birth weight was low (2.3 kg). Six patients had bilateral lesions and 3 patients had phrenic nerve palsy. In their center, the indication for primary brachial plexus exploration is the lack of active elbow flexion against gravity at 4 months of age. A study of the natural history showed that 58% of limbs had full spontaneous recovery, 21% had good but partial recovery, and the prognosis was considered to be poor in the remaining 21% of limbs because active elbow flexion was not evident by 4 months of age. Intraoperatively, the usual lesion was C5/C6 avulsion or avulsion in situ, which seemed to be specific for breech deliveries. Their approach for management is described, including the role of Oberlin's ulnar nerve to biceps nerve transfer in these cases. Finally, the lack of contractures at the shoulder and elbow in these patients are explained. Of 34 upper extremity obstetrical palsies from breech delivery (32 Erb's and 2 total), 58% underwent full spontaneous recovery, and 21% showed substantial partial recovery. Of the remaining 21% who showed no active elbow flexion by four months of age, the C5/C6 avulsion was treated operatively by an Oberlin's ulnar nerve-to-biceps transfer.