Detailed Management of Brachial Plexus Birth Injuries: The Miami Protocol at Nicklaus Children's Hospital

Abstract

The management of children with brachial plexus birth injuries is complex and requires a multidisciplinary approach. In the following article, we describe our approach to evaluation and management at Nicklaus Children's Hospital. It is our aim is to elucidate nuances in management.

Keywords

brachial plexus birth injury - microsurgery - nerve grafting - nerve transfers - Erb's palsy

• References

• 1 Grahn P, Sommarhem A, Nietosvaara Y. A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study. J Hand Surg Eur Vol 2022; 47 (03) 248-256
• 2 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) 2022; 17 (03) 549-557
• 3 Ezaki M, Malungpaishrope K, Harrison RJ. et al. Onabotulinum toxin A injection as an adjunct in the treatment of posterior shoulder subluxation in neonatal brachial plexus palsy. J Bone Joint Surg Am 2010; 92 (12) 2171-2177
• 4 Gilbert A, Raimondi P. Indications of plexus reconstruction in obstetrical paralysis. J Peripheral Nerve Surg 2019; 2 (01) 2-9
• 5 DiTaranto P, Campagna L, Price AE, Grossman JAI. Outcome following nonoperative treatment of brachial plexus birth injuries. J Child Neurol 2004; 19 (02) 87-90
• 6 Immerman I, Valencia H, DiTaranto P. et al. Subscapularis slide correction of the shoulder internal rotation contracture after brachial plexus birth injury: technique and outcomes. Tech Hand Up Extrem Surg 2013; 17 (01) 52-56
• 7 Grossman JAI, DiTaranto P, Yaylali I, Alfonso I, Ramos LE, Price AE. Shoulder function following late neurolysis and bypass grafting for upper brachial plexus birth injuries. J Hand Surg [Br] 2004; 29 (04) 356-358
• 8 Grossman JAI, Price AE, Tidwell MA, Ramos LE, Alfonso I, Yaylali I. Outcome after later combined brachial plexus and shoulder surgery after birth trauma. J Bone Joint Surg Br 2003; 85 (08) 1166-1168
• 9 Greenhill DA, Trionfo A, Ramsey FV, Kozin SH, Zlotolow DA. Postoperative loss of midline function in brachial plexus birth palsy. J Hand Surg Am 2018; 43 (06) 565.e1-565.e10
• 10 Liggio FJ, Tham S, Price A, Ramos LE, Mulloy E, Grossman JA. Outcome of surgical treatment for forearm pronation deformities in children with obstetric brachial plexus injuries. J Hand Surg [Br] 1999; 24 (01) 43-45
• 11 Doi K, Hattori Y, Sakamoto S, Dodakundi C, Satbhai NG, Montales T. Current procedure of double free muscle transfer for traumatic total brachial plexus palsy. JBJS Essential Surg Tech 2013; 3 (03) e16