Not all brachial plexus palsies in neonates are due to birth injury – some uni- or bilateral palsies can be due to other reasons e.g. transverse myelitis, osteomyelitis spine, spinal stroke, spinal abscess
ASSESSMENT OF ALL BABIES WITH REDUCED UPPER LIMB MOVEMENT
- Examine the arm and neck for swelling, bruising, tone, posture and degree of movement
- Assess for breathing difficulties and Horner’s syndrome
- Document findings clearly in case notes
- Explain to parents that recovery probable but may not be complete
- Inform consultant obstetrician/paediatrician (in charge clinician)
MANAGEMENT
- X-ray humerus/clavicle to exclude fracture
- if fracture of clavicle clearly seen, reassure parents and review baby at 3 weeks when movement should be returning
- if fracture of humerus is clearly seen, offer strapping of arm to chest for comfort and contact paediatric orthopaedic surgeon for follow-up
- In case of classical waiter’s tip position or other cases of peripheral nerve injury e.g. radial nerve palsy use TriVice app or web-based application for guidance if unclear pathway (see below)
- refer to Children’s Hand and Upper Limb Service at BCH if no recovery of arm movement at 3 weeks to bwc.handsandupperlimb@nhs.net
- Refer to inpatient neonatal physiotherapist (where service is available) for an assessment before discharge
- If not seen by a physiotherapist before discharge, refer to local children’s community physiotherapy service
- Paralysis of the arm, which is completely resolved does not need to be referred but if there is any doubt, all babies can be seen in a hand clinic, either remotely or face-to-face so that a specialist assessment can be made and the parents can be given appropriate information
BIRMINGHAM CHILDREN’S HAND AND UPPER LIMB SERVICE:
- Fax referrals will not be accepted
- For advice and guidance please use https://bwc.trivice.net or via the app TriVice (Triage, Referral and Advice) which can be downloaded for all NHS staff via App store and google store
- Any referral should be done by letter or email to bwc.handsandupperlimb@nhs.net
- Please click here to view a demo TriVice video: https://youtu.be/sM13U-PJ3Dk
- A guide for referring units can be found here: https://youtu.be/y_sI_h8dbSo
- Email secretary with referral: bwc.handsandupperlimb@nhs.net
- Tel: 0121 333 8136/8285
Date updated: