Obstetrical plexus brachialis lesion diagnostics and treatment: Current trends

Injuries of the brachial plexus most often occur as a result of childbirth trauma, by stretching of the brachial plexus during childbirth, and are therefore called neonatal brachial plexus palsy. Based on the severity of the injury itself, clinically, birth injuries of the brachial plexus are divided into three degrees: a) Complete lesion in which the C5 - Th1 roots are affected; b) Upper type - Erb Duchenne is also the most common type of lesion, where both C5 and C6 roots are damaged, and individual fibers of the C7 root may be affected; c) Lower type - Klumpke Dejarinne represents isolated damage to the lower roots of C8 - Th1. The aim of this paper is to assess the latest recommendations about diagnostic and treatment of brachial plexus birth injuries by browsing the newest scientific evidences. Treatment of birth injuries of the brachial plexus can be conservative, i.e. physiatry and surgery. The aim of the treatment is to increase the functionality of the affected arm through sensorimotor integration and biofeed reintegration, by preventing the occurrence of contractures and strengthening the musculature of the affected hand, as well as by improving trophism, and then preventing bone deformities and late consequences that may occur in these patients (deformities, painful arthrosis, agnosia of the damaged hand). The treatment of neonatal brachial plexus palsy requires a multidisciplinary approach led by a physiatrist in order to determine a change in therapy and further physical treatment, as well as making a decision on further possible surgical treatment. Treatment of children with birth injuries of the brachial plexus is a long-term process and requires continuous monitoring until the completion of bone growth and development.