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Question 46#

In obstetrical brachial plexus palsy (OBPP):

A. 50% of babies proceed to full spontaneous recovery within 3 months
B. Some elbow flexion is present
C. The branches of the posterior cord are unaffected
D. The Oberlin’s transfer can be a useful procedure
E. Horner’s sign is usually present

Correct Answer is D

Comment:

The Oberlin’s transfer can be a useful procedure. Narakas has classified obstetric brachial palsy into the following four groups:

• Group 1 represents classic Erb (C5/C6) palsy with initial absence of shoulder abduction, shoulder rotation, elbow flexion and forearm supination.
• Group 2 includes C7 with absence of wrist and finger extension.
• Group 3 is a flail extremity without a Horner’s syndrome.
• Group 4 is the most severe group - a flail extremity with a Horner’s syndrome. This indicates a very poor prognosis. Presence of a Horner’s syndrome indicates a preganglionic injury to the lower plexus.

Classical Erb’s palsy involves only C5/C6 (c.50%) but it is also common to have C5/C6/C7 involvement. A recent study has shown that 91% of palsies fall into these categories. In group 1, approximately 90% proceed to full recovery, with some evidence of recovery by 3 months. Biceps and brachialis are innervated by C5/C6 and so elbow flexion is absent. Branches of the posterior cord are affected, particularly the branches of the axillary nerve (C5/C6). The Oberlin’s transfer involves moving a fascicle from the ulnar nerve to the motor branch to biceps and can be useful in C5/C6 avulsion.