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LUMBOSACRAL PLEXUS DAMAGE

Lumbosacral plexus lesions are usually due to obstetrical trauma. They are usually associated with breech presentation. Evidence of trauma in other areas may be present.

 

PERIPHERAL NERVE DAMAGE

Peripheral nerve damage is usually due to local nerve trauma. Radial nerve damage has been associated with fracture of the humerus, restricted uterine positions, difficult delivery, or the use of blood pressure cuffs. An area of cutaneous discoloration in the trajectory of the radial nerve or in the posterior interosseous branch may be present.
Median nerve injury in the antecubital fossa is usually due to brachial artery puncture. Median nerve injury is more common in small neonates.
Sciatic nerve injury occurs after injection to the buttocks, prolonged pressure on the buttocks, or infusion of drugs into the umbilical artery. The mechanism of injury with injections to the buttocks is the inflammation associated with the injected substance and not trauma to the nerve by the needle stick as was initially considered. Necrosis of the buttocks may be associated with thrombosis of the inferior gluteal artery. The mechanism of sciatic nerve injury due to infusion of drugs into the umbilical artery is probably thrombosis of the inferior gluteal artery. This artery irrigates the sciatic nerve.
Peroneal nerve injury may be due to compression by uterine bands (Figure 266.1), an ill-applied foot board, or intravenous fluid infiltration.

Figure 266.1. Amniotic band affecting the leg above the ankle.


Injuries to the peripheral nerves do not have any specific treatment other than discontinuing the mechanism of injury if possible. Most neonates with peripheral nerve injuries recuperate with physical and occupational therapy.

 

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Feldman, 1957 Tollner, 1980 Ross, 1983 Volpe, 1995 Gilles, 1991 San Augustin, 1962 Fischer, 1982 Kreusser, 1984