652 The Antecedents, Natural History and Interventions of Brachial Plexopathies (BPS); with Implications for Patterns of Accidental and Nonaccidental Injuries

Abstract

Background / purpose: BPs are defects in the anterior rami of C5 to C6 or C7 -Erbs- Duchenne-(ED), C8 to Th1-Dejerine-Klumpkes- (DK) spinal nerves which impulsates the upper limbs musculatures due to perilesional oedema, haemorrhages, neuro-axonotemesis, contusions or Wallerian degenerations Occasionally BPs-acute traumatic injury (ATI) are radiologically indistinct epi-phenomena in infancy Some of its aspects were either unaddressed/uncharacterized/contentiously discussed or not uniformly adaptable.

Method: A prospective observational study of cases in a single referral centre.

Results: Of the 64 cases, (n=48) were perinatally related.

Appropriately supervised deliveries(n=17)/delayed supervision(n=19)/absolutely

unsupervised(n=12)Localizations: right (n=38). Putatively principal, antecedents'

were macrosomia-dystocia/assisted-breech Limited range of motion,(ROM)/neuro-

myalgia/neurodevelopmental delay/torticollis/facial palsy/sensory defects/flaccidity were eloquently featured.

Anatomical complexities/overlapping effects of BPs rendered classifications oversimplistic, however, an adducted arm /an internally rotated shoulder/a pronated fore arm/a decreased elbow flexion/the presence of a grasp but not a biceps reflex/normal hand (ROM) but no Moro reflex/ nosologically consistent with EDBP(n=34), whereas normal shoulder/elbow use, but hand/fingers palsy/ Horner's syndrome consistent with DKBP (n=4)/ overlapping features(n=10), Predominantly, rap id recovery suggested prognostically excellent neuropraxic sequences, whereas, occasional fibrosing, neuromatous compressive phenomena portended delayed recovery For other subsets, accidental unbalanced differential traction during infant minding, misguided childs play or motoring related ATI (n=16)were significantly implicated precedents suggestive of a disruptive-avulsive

pattern, auguring delayed residual resolutions. Intractable defects despite specific evaluations/ physico-stimulatory interventions implied progression to advanced electrophysiology/imaging, neurolysis, explorative/ reparative interventions or electromyoneurography/novel therapeutic modalities.

Conclusions/importance: The analytic epidemiology of BP is dynamically variable. Experientially, dystocias are important antecedents. Characterizing estimates/patterns of BPs proffers apposite figures for research directions/specific deterrent interventions.

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