Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 2;20(1):e27-e30.
doi: 10.1055/a-2572-2601. eCollection 2025 Jan.

Intraoperative Assessment of Nerve Traction Injury in Obstetric Brachial Plexus Palsy

J Bahm  1 , B Schäfer  1 , K Nolte  2 , J Weis  2 , J P Beier  1
Affiliations

Intraoperative Assessment of Nerve Traction Injury in Obstetric Brachial Plexus Palsy

J Bahm et al. J Brachial Plex Peripher Nerve Inj. .

Abstract

We present an easy classification for nerve lesions observed in reconstructive surgery for obstetric brachial plexus palsy, performed through a supraclavicular approach and systematic exposure of nerve roots and trunks. A description of signs related to nerve traction injury (scarring, fascicular rupture, and dislocated ganglions) is combined with a grading system of microscopic tissue changes occurring in slices from traumatized nerve endings (fascicular structure, changes in perineurium and endoneurium). Both tools are proposed for any surgical brachial plexus exploration and later interaction with other professionals (pediatricians, physiotherapists, or obstetricians).

Keywords: brachial plexus; endoneurium; fibrosis; minifascicles; nerve regeneration; nerve traction; obstetric palsy; perineurium.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Translation of external lateral traction forces between head and shoulder onto the nerve structures of the brachial plexus: ( 1 ) The most lateral structures are first involved, giving rise to superficial scarring and involvement of the upper trunk and especially the origin of the suprascapular nerve. ( 2 ) A more severe force affects the upper and eventually middle trunk, responsible for Erb́s or extended Erb́s palsy. ( 3 ) Major traumatization spreads to the whole brachial plexus, with the most severe damage (including root avulsions) of the lower trunk (in deep blue, bold).
Fig. 2
Fig. 2
Neuropathological tissue changes affecting fascicular structure, endo-, and perineurium.
See this image and copyright information in PMC

References

    1. Bahm J, Ocampo-Pavez C, Disselhorst-Klug C, Sellhaus B, Weis J. Obstetric brachial plexus palsy: treatment strategy, long-term results, and prognosis. Dtsch Arztebl Int. 2009;106(06):83–90. - PMC - PubMed
    1. Lagerkvist A L, Johansson U, Johansson A, Bager B, Uvebrant P. Obstetric brachial plexus palsy: a prospective, population-based study of incidence, recovery, and residual impairment at 18 months of age. Dev Med Child Neurol. 2010;52(06):529–534. - PubMed
    1. Narakas A O, Bora F W. Philadelphia: W.B Saunders; 1986. Injuries to the Brachial Plexus. The Pediatric Upper Extremity: Diagnosis and Management; pp. 247–258.
    1. Al-Qattan M M, El-Sayed A A, Al-Zahrani A Y et al.Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol. 2009;34(06):788–791. - PubMed
    1. Narakas A O.Lesions found when operating traction injuries of the brachial plexus Clin Neurol Neurosurg 199395(suppl):S56–S64. - PubMed

LinkOut - more resources