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Department of Anesthesiology; Director, Pediatric Anesthesiology, Blair E. Batson Hospital for Children, University of Mississippi School of Medicine, Jackson

To the Editor:

In the clinical practice article by David C. Mason, DO, and Carman A. Ciervo, DO,¹ the authors comment on the use of osteopathic manipulative treatment (OMT) for neonates who have Erb-Duchenne palsy, or brachial plexus injuries. The authors thoroughly discuss the anatomic and diagnostic characteristics of this condition. They are also to be complimented for their diagnostic skills. As an osteopathic physician who has participated in the care of infants for more than 15 years, I doubt that many other practitioners could perform the palpatory, visual, and range-of-motion examinations in the unsedated infant that are described by the authors.¹ Certainly, such examinations are beyond my capability. Nevertheless, the potential for using OMT in this condition is interesting.

Unfortunately, Drs Mason and Ciervo¹ present no evidence regarding why OMT techniques useful for thoracic outlet syndrome should also be considered efficacious for Erb-Duchenne palsy. Although their hypothesis that myofascial release can ameliorate this condition is compelling, they present no data—even from their clinical practice—that this treatment approach would be of benefit.

Given the prevalence of brachial plexus injuries in the neonate population² and the novelty of the osteopathic medical approach in such cases, it should be rather simple to undertake a prospective, randomized controlled trial of the authors' suggested techniques with well-defined endpoints to validate their assumptions, which are currently unfounded.

The authors are correct in noting that brachial plexus injuries carry emotional weight for parents and constitute a source of malpractice litigation.¹ In light of this consideration, it is of particular importance that OMT modalities undergo the same scrutiny of the scientific method that is required of more conventional treatment options.

Finally, I fail to understand the point of including unsupported and nonreferenced statements in JAOA—The Journal of the American Osteopathic Association about the alleged benefit of therapeutic touch to "facilitate the body's innate ability to heal."¹ Such statements are not worthy of scientific journals and do nothing to enhance the wider medical community's acceptance of osteopathic medicine.

All scientific discovery begins with unproven assumptions, but it is incumbent on those of us in the osteopathic medical profession to present properly tested and validated data before encouraging the use of new treatment modalities in our patients.

References
1. Mason DC, Ciervo CA. Brachial plexus injuries in neonates: an osteopathic approach. J Am Osteopath Assoc. 2009;109:87-91. Available at: http://www.jaoa.org/cgi/content/full/109/2/87. Accessed April 10, 2009.

2. Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90:1258 -1264.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mychaskiw, G. Search for Related Content PubMed PubMed Citation Articles by Mychaskiw, G., II