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Risk of brachial plexus birth palsy. Necessary diagnostic tests.

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When is there a risk of BPBP? Am I at a higher risk of having another child with BPBP??

The BPBP is usually produced in difficult births. Large fetuses (>4.500 kg) are 15 times more likely to suffer BPBP. The disproportion between the pelvis and the size of the fetal shoulders (shoulder dystocia) increases risk of BPBP up to a hundred times.

If you have had a baby with BPBP, you are more likely to have another baby with the same problem. You should discuss this with your obstetrician and consider cesarean section taking into consideration other factors involved in pregnancy (baby's size, baby’s presentation before delivery, pelvis shape, etc.).

What diagnostic tests are needed for my baby? Is it necessary to do electromyography (EMG) or magnetic resonance imaging (MRI)?

  • The EMG has no role in the BPBP, since it underestimates the degree of nerve injury.
  • MRI requires general anesthesia and should NOT be done in all BPBP. Its main indication is suspicion of nerve avulsions (Figure 8). At older ages, it is considered as the imaging test of choice in the study of glenohumeral dysplasia (GHD).


Figure 8. MRI: the white “balls” located in the cervical spine suggest avulsion of the inferior cervical nerve roots (circle).


  • The use of cervical ultrasonography is increasing for diagnosing suspected avulsions. It will also be useful in the diagnosis of glenohumeral dysplasia.
  • The chest x-ray and ultrasound are indicated in the context of a total brachial plexus palsy, to rule out the paralysis of the diaphragm, meaning avulsion of the superior cervical nerve roots.
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