Trauma: Obstetrical Brachial Plexus Palsy from Birth Trauma
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Animation: Image diagnosis of nerve disruption in obstetrical brachial plexus palsy.
(A) Three-month-old child with complete flail arm. Image demonstrates absence of plexus elements in area of trunks. A hypointense round (r) abnormality proved to be a mass of disrupted scarred scalene muscle partially incorporating shards of nerve remnants. In this situation, nerve grafts can be used to bridge gaps. In addition, neuroplasty or removal of adhesions helps improve recovery.
(B) Six-month-old child with persistent upper trunk paresis. Imaging confirmed ball neuromas at C5 and C6 demonstrating complete disruption of upper trunk elements. Early demonstration of complete disruption with terminal nerve neuromas can allow for an earlier decision for restorative surgery and hence better outcomes.
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