• It is seen with a frequency of 0.6-4.6/1000 in live births and nearly half of them developed as a result of shoulder dystocia. The most commonly broken bone at birth is the clavicle.
Predisposing factors to birth trauma:
• Macrosomia
• Head-pelvis incompatibility
• Prematurity
• Postmaturity
• Prolonged or rapid delivery
• Multiple pregnancy
• Vacuum-forceps application
• Abnormal presentation (breech, forehead, face, shoulder)
- Brachial Plexus Injuries
Erb-Duchenne type brachial plexus injury
• Has CS-6 damage.
• The arm is in internal rotation and adduction from the shoulder, the forearm is in extension and pronation, and the wrist is in flexion (tip hand). The catching function of the hand is preserved.
Unilateral Moro reflex is absent.
Klumpke type brachial plexus injury
• C7-8 has T1 damage.
• Hand is low, forearm is supinated, fingers are extended. There is edema and cyanosis of the hand.
The catching function of the hand is impaired. Even if the Moro reflex is weak, it is taken. If the cervical sympathetic branches of T1 are also damaged, Horner's syndrome (ptosis, miosis) develops.
In brachial plexus injuries, MRI can show whether the source of the problem is a complete rupture or avulsion. After 2 weeks of immobilization in the appropriate position, physical therapy is required. If functions have not returned, there is a high probability of injury requiring surgery.
Phrenic nerve paralysis
• Occurs in case of cervical 3rd, 4th and 5th nerve injury.
• It is characterized by cyanosis and irregular breathing.
• Diaphragmatic eventration occurs on the affected side and respiratory sounds are reduced. Diagnosis is made by ultrasonography or fluoroscopy.
- Sternocleidomastoid Muscle Injury
• A firm, immobile, well-circumscribed mass is palpated in the middle of the sternocleidomastoid muscle.
• The head is tilted to the affected side, the chin is turned to the opposite shoulder. The head cannot be passively returned to the normal position.
• Definitive diagnosis is made by ultrasonography.
• Exercise is done in the opposite direction of this position.