Benjamin Kathleen
Children's Hospital, Denver, CO 80218, USA.
Adv Neonatal Care. 2005 Aug;5(4):181-9. doi: 10.1016/j.adnc.2005.03.004.
Upper-arm weakness (paresis) or paralysis indicates peripheral-nerve damage to the brachial plexus, a network of lower cervical and upper thoracic spinal nerves supplying the arm, forearm, and hand. Physical findings reflect muscle paralysis from spinal nerve roots. The mechanism of injury includes maternal, obstetric, and infant factors that apply traction on or compression to the anatomically vulnerable brachial plexus. Nerve regeneration can occur if nerve tissue components are preserved. Recovery is affected by multiple factors, including the type and site of injury, intervention timing, and developmental factors. The majority of injuries recover in days or months; however, residual deficits can persist. Part 1 of 2 of this article provides an overview of the neurophysiology of peripheral-nerve damage and nerve regeneration. The multifactorial etiology of brachial plexus injuries will be reviewed. Photographs and on-line video clips will enhance the description of the brachial plexus injury classifications and illustrate mechanisms of shoulder dystocia and obstetric relief maneuvers. A systematic approach to the physical examination will be explored in Part 2. Serial evaluation of motor function recovery is essential and is accomplished by appropriate referrals and follow-up. Part 2 will also describe treatment options and discuss anticipatory parent guidance.
上臂无力（轻瘫）或麻痹表明臂丛神经受到外周神经损伤，臂丛神经是由下颈段和上胸段脊神经组成的网络，为手臂、前臂和手部提供神经支配。体格检查结果反映了脊神经根导致的肌肉麻痹。损伤机制包括母体、产科和婴儿因素，这些因素会对解剖结构上较为脆弱的臂丛神经施加牵引或压迫。如果神经组织成分得以保留，神经可以再生。恢复受多种因素影响，包括损伤的类型和部位、干预时机以及发育因素。大多数损伤在数天或数月内恢复；然而，残留的功能缺陷可能会持续存在。本文分为两部分，第一部分概述外周神经损伤和神经再生的神经生理学。将回顾臂丛神经损伤的多因素病因。照片和在线视频片段将加强对臂丛神经损伤分类的描述，并说明肩难产的机制和产科助产手法。第二部分将探讨体格检查的系统方法。对运动功能恢复进行系列评估至关重要，可通过适当的转诊和随访来实现。第二部分还将描述治疗选择并讨论对家长的预期指导。
