Secuela de las paralisis obstetricas del hombro / Shoulder deformities and sequelae secondary to brachial plexus birth palsy

Introducción: Es una afección infrecuente; nuestra experiencia consiste en 92 casos tratados en 25 años. Materiales y métodos: De los 92 pacientes operados, 67 presentaron deformidades osteoarticulares y 31, deformidades de las partes blandas. La metodología fue retrospectiva clínico-funcional, analítica y descriptiva considerando las historias clínicas y la valoración personal. Para el tratamiento se utilizó el algoritmo de Bennett y Christopher. Se efectuó en ocasiones la microcirugía temprana del plexo. A los 4 años algunos pacientes pueden requerir cirugías paliativas. Resultados: Con las cirugías del plexo y paliativas, se consiguió, en las lesiones C5-C6, la recuperación hasta en el 80 por ciento de los casos. Tratándose de cuadros distintos no comparables que requieren técnicas diversas, se consideraron los resultados en un porcentual global. Conclusiones: La reparación microquirúrgica del plexo braquial, efectuada en tiempo y forma, mejora los resultados en hasta un 75 por ciento. Agrupamos las secuelas en dos grandes grupos: uno sin alteraciones en la morfología osteoarticular y uno con ellas (displasia glenoidea, retroversión de la cabeza humeral y aplanamiento de la cabeza humeral). Las técnicas originales de Sever y de Sever-L'Episcopo están proscritas. Destacamos la utilidad del procedimiento de Roper efectuado antes de los 5 años de edad. Entre las cirugías del plexo y paliativas se puede lograr, en las lesiones C5-C6, una recuperación de hasta el 80 por ciento.

Electromyographic Studies of Obstetrical Palsy

Electromyography and related electrodiagnostic techniques are being applied to clinical studies of neuromuscular diseases with increasing frequency and effectiveness. Four patients with obstetrical palsy were examined and followed up with electromyography. The findings from clinical observation and electromyographic studies were discussed in regard to the site of the lesion, prediction of prognosis and the degree of nerve regeneration. It is emphasized that findings provided by electromyographic examinations can not only contribute to accurate diagnosis, but also serve as a guide for selecting appropriate means of treatment with physical therapy for the patients with obstetrical palsy as well as to monitor progress, by doing a series of periodic examinations. Adler and Patterson(1967) reported that the incidence of Erb's palsy has remarkably decreased. From 1939 to 1962 they found only one hundred and twenty three cases instead of four hundred and ninety one cases in the period from 1928 to 1939 at the Hospital for Special Surgery. Statistics on obstetrical palsy due to the brachial plexus injury are not available in Korea. It is assumed however that its incidence here must also be decreased as the obstetric services have advanced significantly in recent years. The clinical picture of a brachial plexus palsy is dependent on the location of the pathology in the plexus and it is not easy to predict the prognosis without knowledge of the degree of injury. With electromyographic studies it is possible to detect the exact site of the lesion in the brachial plexus, the degree of injury and the progress of nerve regeneration. Therefore, it is a useful tool for making accurate diagnosis and prognosis and the findings provided by the electromyographic studies permit appropriate selection of treatment as the nerve regeneration takes place. Four cases of obstetrical palsy of the brachial plexus were referred to Severance Hospital for electromyographic examination and subsequent treatment from February to September 1972.

Electromyographic Studies of Obstetrical Palsy

Electromyography and related electrodiagnostic techniques are being applied to clinical studies of neuromuscular diseases with increasing frequency and effectiveness. Four patients with obstetrical palsy were examined and followed up with electromyography. The findings from clinical observation and electromyographic studies were discussed in regard to the site of the lesion, prediction of prognosis and the degree of nerve regeneration. It is emphasized that findings provided by electromyographic examinations can not only contribute to accurate diagnosis, but also serve as a guide for selecting appropriate means of treatment with physical therapy for the patients with obstetrical palsy as well as to monitor progress, by doing a series of periodic examinations. Adler and Patterson(1967) reported that the incidence of Erb's palsy has remarkably decreased. From 1939 to 1962 they found only one hundred and twenty three cases instead of four hundred and ninety one cases in the period from 1928 to 1939 at the Hospital for Special Surgery. Statistics on obstetrical palsy due to the brachial plexus injury are not available in Korea. It is assumed however that its incidence here must also be decreased as the obstetric services have advanced significantly in recent years. The clinical picture of a brachial plexus palsy is dependent on the location of the pathology in the plexus and it is not easy to predict the prognosis without knowledge of the degree of injury. With electromyographic studies it is possible to detect the exact site of the lesion in the brachial plexus, the degree of injury and the progress of nerve regeneration. Therefore, it is a useful tool for making accurate diagnosis and prognosis and the findings provided by the electromyographic studies permit appropriate selection of treatment as the nerve regeneration takes place. Four cases of obstetrical palsy of the brachial plexus were referred to Severance Hospital for electromyographic examination and subsequent treatment from February to September 1972.