Brachial Plexus Injuries, Obstetrical Workup

  • Author: Susan E Mackinnon, MD, FRCSC, FACS; Chief Editor: Dennis P Grogan, MD   more...
 
Updated: Sep 16, 2010
 

Laboratory Studies

  • No specific laboratory studies are helpful in diagnosing patients with obstetrical brachial plexus paralysis (OBPP).
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Imaging Studies

  • MRI is indicated to evaluate for avulsion of the nerve roots from the spinal cord.
  • A chest radiograph is used to evaluate patients for phrenic nerve paralysis.
  • Fluoroscopy of the diaphragm may be necessary.
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Other Tests

Electromyography (EMG) and nerve conduction studies are less useful for patients with obstetrical brachial plexus paralysis (OBPP) than they are for adults with brachial plexus injuries.

  • With electromyography, fibrillations are associated with denervation and will become apparent approximately 4-6 weeks following injury.
  • Motor unit potentials suggest reinnervation or collateral sprouting.
  • In general, EMG findings may be misleadingly optimistic.[22]
  • Most surgeons believe that clinical examination is a better prognostic indicator than is EMG.
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Contributor Information and Disclosures
Author

Susan E Mackinnon, MD, FRCSC, FACS  Program Director, Division of Plastic and Reconstructive Surgery, Shoenberg Professor and Chief, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine

Susan E Mackinnon, MD, FRCSC, FACS is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, American Society of Plastic Surgeons, American Surgical Association, Association of Women Surgeons, Canadian Medical Association, Canadian Society of Plastic Surgeons, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, Society for Neuroscience, and World Society for Reconstructive Microsurgery

Disclosure: Synovis Royalty Consulting; AxoGen Grant/research funds Consulting

Coauthor(s)

Christine B Novak, PT, MS  Clinical Coordinator, Division of Plastic and Reconstructive Surgery, Research Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine

Christine B Novak, PT, MS is a member of the following medical societies: American Association for Hand Surgery

Disclosure: Nothing to disclose.

Mark E Baratz, MD  Professor, Department of Orthopaedics, Drexel University College of Medicine; Residency Director, Department of Orthopaedics, Allegheny General Hospital; Consulting Staff, Allegheny Orthopaedic Associates

Mark E Baratz, MD is a member of the following medical societies: Allegheny County Medical Society, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Surgery of the Hand, Orthopaedic Research Society, and Pennsylvania Orthopaedic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mininder S Kocher, MD, MPH  Associate Professor of Orthopedic Surgery, Harvard Medical School/Harvard School of Public Health; Associate Director, Division of Sports Medicine, Department of Orthopedic Surgery, Children's Hospital Boston

Mininder S Kocher, MD, MPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the History of Medicine, American Medical Association, American Orthopaedic Society for Sports Medicine, and Massachusetts Medical Society

Disclosure: Smith & Nephew Endoscopy Consulting fee Consulting; ConMed Linvatec Consulting fee Consulting; Covidian Consulting fee Consulting; EBI Biomet Consulting fee Consulting; OrthoPediatrics Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

George H Thompson, MD  Director, Pediatric Orthopedics, Rainbow Babies and Children's Hospital

George H Thompson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: OrthoPediatrics None Consulting; Journal of Pediatric Orthopaedics Salary Management position

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dennis P Grogan, MD  Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa

Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: Nothing to disclose.

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Schema of the brachial plexus.
 
 
 
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