Birth-Related (Obstetrical) Brachial Plexus Injuries Workup

Updated: May 10, 2018
  • Author: Alison Snyder-Warwick, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Workup

Laboratory Studies

Before any lengthy surgical procedure in the vicinity of large vessels, a hemogram should be obtained and coagulation factors checked.

No specific laboratory studies are helpful in diagnosing patients with birth-related brachial plexus palsy (BRBPP).

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Imaging Studies

Computed tomography (CT) myelography or magnetic resonance imaging (MRI) is useful to help predict locations of nerve root avulsion. Diaphragmatic ultrasonography (US) is used to evaluate phrenic nerve function.

Glenohumeral dysplasia (GHD) is assessed by means of US, radiography, MRI, or CT. [71, 72] Three-dimensional (3D) imaging provides a more comprehensive view of glenohumeral deformation than two-dimensional (2D) radiography does. [21, 73]

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Other Tests

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

With EMG, fibrillations are associated with denervation and become apparent approximately 4-6 weeks following injury. Motor unit potentials suggest collateral sprouting, indicating recovery, but may not appear on EMG testing until 12 weeks after injury. In general, EMG findings may be misleadingly optimistic. [74] Most surgeons believe that clinical examination is a better prognostic indicator than EMG.

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