Upper limb birth injuries including brachial plexus injury

DO NOT USE FOR CLINICAL PRACTICE
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

TYPES OF BIRTH-RELATED UPPER LIMB INJURIES

Brachial plexus palsy may be congenital occurring in-utero or acquired due to injury to brachial plexus nerves sustained due to stretching of nerves during delivery – may be unilateral or bilateral and can be associated with fractures of the ipsi- or contralateral clavicle or humerus
Isolated fractures to humerus or clavicle
Isolated radial nerve palsy of the newborn

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

See Guideline Supporting Information