Prediction of functional outcome of obstetric brachial plexus palsy

الملخص EN

Objective : the aim of this work was to identify parameters that might improve the prediction of recovery of obstetrical brachial plexus palsy (OBPP).

Methodology : Twenty-four OBPP children were included in this study.

They were classified into 4 groups: C5-6, C5-7 and C5-T1 without and with Horner’s syndrome.

Clinical evaluation was done every 3 months and follow-up until the age of one year using the following methods : 1- Hospital for sick children (HSC) grading system : where elbow flexion elbow, wrist, finger and thumb extensors were evaluated.

Score 3.5 or more at 3 months is with good prediction of outcome at final assessment.

2- Shoulder function assessment according to Mallet where, global abduction, global external rotation, hand to neck, hand to spine & hand to mouth were evaluated.

3- Hand function grading after Raimondis (6 grades).

4- Functional recovery good or poor after Mallet.

Results : Group I comprised 8 patients, group II 6 patients and groups III & IV 5 patients each.

Four (16.6 %) patients recovered completely.

Two (8.2 %) patients had persistent deficit with no treatment and reasonable functions.

Seven patients (29.16 %) needed a second operation.

Eleven patients (45.83 %) were operated upon for primary plexus repair ; 5 of them were in group IV (all patients).

The HSC system was more than 3.5 in 7 patients at the age of 3 months.

All showed good prediction according to HSC at final assessment.

In two patients in whom HSC showed a score less than 3.5 improvement occurred at 6 months of age.

Shoulder function assessment more than 2 and hand grade more than 3 was with good prediction.

The functional recovery system is not suitable for prediction of recovery.

Conclusion: From this study we can recommend using for group I & II (3.5 or more) HSC scoring system at 6 months of age together with shoulder function system 2 grade or more.

And for group III & IV, abduction of grade 2 & grade 3, hand function or more.

Also it is recommended to use functional recovery system graded good, moderate & poor where.

Good : Complete recovery or elbow range of motion > 90° with M3 or higher biceps.

And shoulder abduction > 120° with external rotation > 25°.

Moderate: Shoulder abduction <120° and weak external rotation.

And elbow range of motion > 90° or biceps power > M2.

Poor : Biceps less than M2 or elbow range of motion < 90° or absence of recovery.