Considerations of Pain from Infancy through Adolescence in Patients with Obstetrical Brachial Plexus Palsy: A Retrospective Analysis
Meg Stanger, PT; Megan Natali, PA; Lorelei J Grunwaldt, MD; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
In the obstetrical brachial plexus palsy (OBPP) population, pain is understudied. This, in part, is due to the difficulty in obtaining this data for infants and young children as well as understanding the possible etiologies of pain. Pain may result from the initial injury itself, recovery of the nerves, and secondary musculoskeletal impairments that may develop.
A retrospective chart review of all OBPP patients seen at our institution between January 2012 and June 2016 was performed. Data was collected on demographics and subjective reporting of pain by the caregiver or the patient.
Of the 178 patients with OBBP, 149 patients were < or = 10 years of age and 29 patients were > or = 10. 50 patients reported to have pain during at least one visit. This correlates with 28% of the patients with an OBPP at our institution reporting a complaint of pain at least once. Of note, 41% of the children in the over 10-year age category complained of pain.
Pain symptoms can be divided into four main groups. In those with pain under age 10, the pain was noted by the parent and typically correlated to the time-period around the initial injury. The pain was noted as increased fussiness with manipulation of the arm in the young infants within the first 2-3 months of life. There were 13 patients in this category. The second group are those who may not be able to articulate pain or tingling but manifested this discomfort by biting or picking their limb. There were 3 patients in this group, including 1 child who displayed significant self-mutilation of his fingers. The final group of 12 children were older than 10 years of age and articulated their pain as dull, aching, tightness or severe pain that interfered with function and sleep.
Pain in OBPP patients is a real entity with up to 28% patients at our institution reporting having pain. It is important to understand how pain manifests as it can affect long term outcome. Although function is the main concern in this cohort, we should collect more objective data on pain and attempt to identify the etiology of the pain. Identifying the causative factors of pain is crucial to minimize the effects of pain on function and quality of life for these patients but also to identify possible risk factors early before function and quality of life may be affected.
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