Management of Brachial Plexus Birth Injuries at British Columbia Children's Hospital

Abstract

A multidisciplinary team at BC Children's Hospital provides brachial plexus birth injury management for our provincial catchment area. Although compared with many centers we service a relatively small clinic population, we have the benefit of universal health care, province-wide reach, and accessible research infrastructure. In 2008, we created the Sup-ER protocol, which includes an orthosis that passively positions the neonatal shoulder into more idealized glenohumeral contact during early growth. We have since shown that our Sup-ER patients have better shoulder outcomes, require less brachial plexus surgery, and need fewer shoulder tendon transfers than those patients treated in our clinic prior to 2008. We have also found that the rate and degree of elbow flexion contractures are reduced compared with results reported in the literature.

Keywords

brachial plexus birth injury - Sup-ER - shoulder - orthosis - preventive care

Publication History

Article published online:
26 July 2023

• References

• 1 Coroneos CJ, Voineskos SH, Coroneos MK. et al; Canadian OBPI Working Group. Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system. J Neurosurg Pediatr 2016; 17 (02) 222-229
• 2 Borschel GH, Clarke HM. Obstetrical brachial plexus palsy. Plast Reconstr Surg 2009; 124 (1, Suppl): 144e-155e
• 3 Verchere C, Durlacher K, Bellows D, Pike J, Bucevska M. An early shoulder repositioning program in birth-related brachial plexus injury: a pilot study of the Sup-ER protocol. Hand (N Y) 2014; 9 (02) 187-195
• 4 Yefet LS, Bellows D, Bucevska M. et al. Shoulder rotation function following the Sup-ER protocol in children with brachial plexus injuries. Hand (N Y) 2020; 17 (03) 549-557
• 5 Yefet L, Bellows D, Bucevska M. et al. Can the Sup-ER protocol decrease the prevalence and severity of elbow flexion deformity in brachial plexus birth injuries?. Hand (N Y) 2022
• 6 BC Children's Hospital Research Institute. Treatment of brachial plexus palsy. Accessed January 3, 2023 at: https://www.bcchr.ca/brachial-plexus
• 7 Curtis C, Stephens D, Clarke HM, Andrews D. The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg Am 2002; 27 (03) 470-478
• 8 Durlacher KM, Bellows D, Verchere C. Sup-ER orthosis: an innovative treatment for infants with birth related brachial plexus injury. J Hand Ther 2014; 27 (04) 335-339 , quiz 340
• 9 Bauer AS, Lucas JF, Heyrani N, Anderson RL, Kalish LA, James MA. Ultrasound screening for posterior shoulder dislocation in infants with persistent brachial plexus birth palsy. J Bone Joint Surg Am 2017; 99 (09) 778-783
• 10 Vathana T, Rust S, Mills J. et al. Intraobserver and interobserver reliability of two ultrasound measures of humeral head position in infants with neonatal brachial plexus palsy. J Bone Joint Surg Am 2007; 89 (08) 1710-1715
• 11 Wong V, Balumuka DD, Tuen YJ. et al. How institution of the Sup-ER protocol in a clinic changed procedure patterns and functional outcomes of upper brachial plexus (Erb's type) birth injuries. HAND 2023; (e-pub ahead of print) DOI: 10.1177/15589447231184896.
• 12 Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin 1995; 11 (04) 563-580 , discussion 580–581
• 13 Ho ES, Klar K, Klar E, Davidge K, Hopyan S, Clarke HM. Elbow flexion contractures in brachial plexus birth injury: function and appearance related factors. Disabil Rehabil 2019; 41 (22) 2648-2652
• 14 van der Sluijs MJ, van Ouwerkerk WR, van der Sluijs JA, van Royen BJ. Elbow flexion contractures in childhood in obstetric brachial plexus lesions: a longitudinal study of 20 neurosurgically reconstructed infants with 8-year follow-up. J Brachial Plex Peripher Nerve Inj 2015; 10 (01) e15-e22