OBPtalk - Brachial Palsy: Prediction & Prevention....

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Brachial Palsy: Raphi Pollack, MDCM, FRCSC. Bikur Cholim Hospital, Jerusalem.
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Outline History Natural history Risk Factors Prevention strategies Conclusions
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History Smellie 1764 Erb 1874 “delivery paralysis” related to “moderately energetic manipulation by the obstetrician”
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Significance of Brachial Palsy Complication of birth trauma Major cause of neonatal morbidity “Fetal-physician” risk Accounts for 4.2% of OBS litigation
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8 7 9 4 5 6 3 2 1 Roots Trunks Cords Nerves ANATOMY OF THE BRACHIAL PLEXUS Ulnar Median Radial 7 8 9 5 Lateral Posterior Medial 4 6 Upper Middle Lower 1 2 3
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Clinical Syndromes Erb Palsy C5, C6 root avulsion Upper trunk plexopathy “Waiters tip” position +/- Horner syndrome
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Clinical Syndromes Flail arm Injury to entire plexus Klumpke palsy Lower trunk (C8, T1) injury Poor grasp, proximal function preserved
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Electrodiagnosis Nerve conduction studies Electromyography Study of motor unit potential Technically difficult in the neonate Insights into pathogenesis
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Electrodiagnosis: Timing of Injury Fibrillations Onset = 12-21 days
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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OBPtalk - Brachial Palsy: Prediction & Prevention....

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