Follow-up studies of the obstetrical brachial plexus injury

Abstract

Aims: The overall aim of these studies were to investigate the influence of different kinds of treatment of the obstetrical brachial plexus lesion, and to study functioning and participation in adolescents with OBPP.

Methods: Study 1 involved 247 children with obstetrical brachial plexus palsy (OBPP) of different severity, some of whom had been operated on, with nerve reconstruction being carried out during the first year of life, and with others not having been operated on. All participants were examined at five years of age using a protocol to evaluate the motor and sensory function including range of motion, grip strength, dexterity, tactile sensibility, hand preference and bimanual activity. In Studies 111 and IV, 59 adolescents were clinically assessed according to the protocol used in study 1, and the results were compared. In study 11, 51 adolescents who had participated in study I and 116 age-matched adolescents answered a questionnaire concerning their daily life, school performance and friendships.

Result: The overall shoulder activity was better in the nerve-reconstructed group than in the non-operated group at 5 years of age. The groups had not been randomised and were not completely comparable, but the difference was significant and indicates a better range of shoulder motion after nerve reconstruction. The time of the operation, whether it took place before or after 6 months of age, did not influence the result. A decrease in grip strength and bimanual function was found in children/adolescents with C5- lesions. Sixty-eight percent of the children/adolescents with right-sided OBPP were lefthanded. Children with complete OBPP had a more severe disability with impact on grip strength, dexterity and sensibility as well as on some ADL functions. In the long time follow-up, study Ill, we found that active joint motion in the shoulder and hand function, especially grip strength, generally remained unchanged or improved somewhat, whereas a slight but significant deterioration occurred in the elbow function. Shoulder surgery resulted in considerable improvement of the shoulder function. Children/adolescents who had undergone nerve reconstruction had a similar profile of change as the non-operated group.

We could not find any relationship between differences in the ROM and participation in sports, even if some of the adolescents who participated extensively in sports at a competitive level had improved both their shoulder and arm function without having an operation. Considerable EMG changes in the deltoid can be seen in OBPP even in those who had fully, and the changes deteriorate with time. The sensibility is considerably less affected than motor function in young people with OBPP The majority of the children/adolescents (75 %) did not perceive that they had any problems at all as far as ADL were concerned. This applied to 85 % of the participants with C5-6 involvement and 70 % of them in the C5-7 group. Adolescents with OBPP in our society, report that they live a typical teenage life. However, indications of distress and worry related to the disability should not be overlooked.