DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
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