Brachial plexus palsy in neonates and children.

In 135 children with obstetrical palsy, clinical and electrodiagnostic studies on inital and serial evaluation aided in designing a conservative treatment program. Prevention of contractures, maintenance of muscle strength and reinforcing the child's awareness of the affected limb were predicated on the limiting factors of permanent denervation and agnosia. Instability of the scapula, scapulohumeral adhesions and elbow flexion with loss of active supination defy conventional range of motion exercises. Forced passive supination of the elbow may actually compound the problem of radial head dislocation and ulnar bowing. Because of the young age of most of the patients, only 7 have had orthopedic intervention. Rotational osteotomy of the humerus and transfer of intact muscles seem to improve function. Prior to selection of muscles for transfer, electromyography is advised. Later surgical treatment of the shoulder and elbow seems to improve cosmesis but not function. Of the 135 children, 70% had mild residua, 22% showed moderate impairment and 8% had severe deficit.

Nerve conduction velocity determinations in juvenile diabetes: continuing study of 190 patients.

Few prospective studies on the concomitant finding of neuropathy in juvenile diabetics exist. An ongoing study of motor and sensory nerve conduction determinations in 190 diabetic children, with sequential studies in 108 of them over an eight-year period, is the subject of this report. The incidence of neuropathy in our sample population under five years of age is neglible. In the children over five years of age, 8% had abnormal nerve conduction velocity (NCV) of the peroneal nerve, 4.5% had abnormal median motor and sensory NCV on initial study. In the sequential studies of the children over five years of age, the percentage of abnormal NCV rose from 14% to 48% as the duration of diabetes increased from one year to more than five years. It is the older juvenile diabetics with the longest duration of diabetes who would appear to have the highest incidence of neuropathy.