Peripheral nervous system trauma

Peripheral nervous system birth trauma is the damage of nerve roots, nerve plexus, peripheral and cerebral nerves affected by an external mechanical agent during childbirth. The force of such an impact far exceeds the endurance limit of specified anatomical formations; as a result the compression, destruction or tissue rupture may occur. All these disorders are accompanied by local or systemic circulation abnormalities, oedema, bone fractures, etc. The act of delivery is a very complex process, consisting of constriction injury, rotation, compression and traction. In case of worsening with the fetal malpresentation, large fetal sizes or midwifery forceps usage the probability of birth trauma is very high.

The types of peripheral nerves damage pathomorphological classification:

1. Total (preganglionic) separation of the nerve root from the spinal cord;
2. Postganglionic root rupture;
3. Axon rupture with preservation of the myelin sheath;
4. Nerve “Hurt” with axon preservation and myelin sheath.

The last damage type is least traumatizing and creates all the opportunities for a peripheral nerve complete recovery.

Any kind of nervous system birth trauma requires patient’s obligate examination by a neurologist. You can get a qualified consultation of an experienced physician at the “Bersenev’s Medical Centre”. For several decades our clinic has been specializing in spine and nervous system disease treatment, including birth trauma.

The most common are traumas of the brachial plexus, facial, diaphragmatic, radial and median nerves. Usually they occur in case of using the midwifery forceps.

The brachial plexus trauma mostly occurs when applying obstetric tools, which are used when the fetal head and shoulders are difficult to remove.

As a result of head or shoulders tractions and rotations, the upper and thoracic segments roots of the spinal cord stretch over the neck bones transverse processes.

A brachial natal plexoneuropathy was first described by scientists Duchenne (1872) and Klumpke (1885).

Obstetric paresis (brachial plexus trauma) is often observed in children born in the foot or breech presentation, with a heavy weight, contracted pelvis, excessive tractions of the fetal head, neck compression, difficulty while removing the shoulders or tilting the fetus arms.

Depending on the level of damage, brachial plexoneuropathy is divided into three main categories:

• upper (proximal) type
• lower (distal) type
• total type

Erb-Duchenne palsy or upper (proximal) type

This is the most common type of birth palsy, which occurs 1 time for every 1500-2000 births and is associated with the primary fascicles of brachial plexus damage or C5-C6 cervical roots.

The clinical appearance is characterized by the fact, that the affected upper limb hangs weakly along the trunk, is unbent in all joints and turned inwards; the hand in the palmar flexion is turned back and out (a Novik’s  characteristic symptom of the “doll’s hand”). The shoulder is lowered. The shoulder and forearm muscles atrophy, the inability to raise the shoulder above the horizontal level, bend at the elbow joint are obserevd, i.e. the condition is characterized by a disorder of the function of proximal part of the arm; the movements in the fingers are preserved.

The head is often inclined and turned to the paretic shoulder, due to this the neck seems shortened and with a lot of transverse folds. There is also a muscle tone decrease in the proximal limb and a reflex from the biceps and triceps muscles is absent.

In some cases, the roots of C3-C4 are involved in the process, and then symptoms typical for damage to the phrenic nerve (rapid breathing, shortness of breath, hiccups, cyanosis, and asymmetry of chest movements) prevail in the clinical picture.

Déjerine-Klumpke palsy or lower (distal) type

This type of plexopathy occurs during the spinal cord trauma at C7-T1 level or middle and lower fascicles of the brachial plexus. It is much less common than the proximal (upper) type of lesion and is characterized by upper limb distal segment impairment. It is characterized by a sharp decline or complete loss of hand and fingers’ flexor muscles function. The hand hangs passively, there are no movements, and muscle tone is reduced. In some cases the hand is in the “clawed paw” position, which is associated with radial or ulnar nerves fibre damage.

Sometimes due to a median nerve involvement an “ischemic glove” symptom appears. This symptom is associated with the trophic disorders (hand skin blushing or blanching, swelling).

Total superior paraplegia (Kerer’s paralysis)

The total type of trauma is noted at the spinal cord C5-T1 segment level for which the symptoms of the proximal and distal types of obstetric palsy are peculiar. This is the most difficult type of the obstetrical palsy. The complete hand immobility, muscle hypotension, trophic disorders, prolapse of reflexes, reduction of all kinds of sensitivity are being observed.

Seventh cranial nerve damage

The seventh cranial nerve damage is observed with facial presentation, a long-time head standing in the birth canal, contracted pelvis, while parotid gland compression with the obstetric forceps; in spontaneous delivery.

Statistics proves that the facial paresis in 80% of cases is associated with the forceps application.

In the clinical picture the mimic muscles hemiplegia prevails: the mouth angle is lowered, which is especially noticeable while crying; the nasolabial fold on the side of lesion is mild; the child is not able to close his/her eyes; the Kussmaul’s search reflex is reduced or absent; there are no forehead wrinkles and folds.

Lumbar plexus palsy is rare enough and appears as a result of an awkward legs extraction of the fetus.

At “Bersenev’s medical centre” we apply the unique therapeutic method, which contributes to the restoration of affected nerve fibres. The metameric treatment method, which was developed and introduced into practice by doctor Bersenev, for several decades, has been fighting against central and peripheral nervous system diseases. Metameric method contributes to the peripheral nervous system regeneration due to the combination of reflexotherapy and the neurotrophic medication effect. By making an appointment for a consultation at our medical center, you will get qualified answers from neurologists and learn how to treat the peripheral nerves, roots and plexuses injuries. An individual treatment and rehabilitation program is developed for each patient in order to get optimum result.

To make an appointment for a consultation or a treatment session, please, call (044) 272-11-82 (children’s department), (044) 238-22-31 (call centre) or fill out the online form on our “Bersenev’s medical centre” website.