Outcome Following Nonoperative Treatment of Brachial Plexus Birth Injuries

Abstract

Ninety-one infants who sustained a brachial plexus birth injury were treated with only physical and occupational therapy. The children were evaluated at 3-month intervals and followed for a minimum of 2 years. Sixty-three children with an upper or upper-middle plexus injury recovered good to excellent shoulder and hand function. In all of these children, critical marker muscles recovered M4 by 6 months of age. Twelve infants sustained a global palsy, with critical marker muscles remaining at M0-M1 at 6 months, resulting in a useless extremity. Sixteen infants with upper and upper-middle plexus injuries failed to recover greater than M1-M2 deltoid and biceps by 6 months, resulting in a very poor final outcome. These data provide useful guidelines for selection of infants for surgical reconstruction to improve ultimate outcome.

Current Concepts in the Management of Brachial Plexus Birth Palsy

“…10 Although true natural history studies are rare, a series by DiTaranto et al observing 63 patients without access to microsurgery reported that no child with full recovery of motor function had complete palsy and nerve root avulsion. 11 These observations are similar to those found by Eng et al 12 In patients with incomplete return of function, long-term prognosis is contingent upon neurologic recovery. Nerve root avulsions, the presence of a total plexopathy in infancy, and Horner's syndrome are poor prognostic factors.…”

“…Differences in the strength of muscles surrounding the shoulder joint can lead to soft tissue and joint contractures as well as glenohumeral joint deformity. 11,15 In addition to a better understanding of the natural history of brachial plexus injuries in terms of neurologic recovery, it is important for research to address the concerns that families and patients have regarding the appearance and limitations in daily activities resulting from the injury. Bae et al noted that upper arm, forearm, and hand lengths of the affected limbs were on average 95%, 94%, and 97%, respectively, compared with the unaffected side.…”

Early Operative Intervention for Selected Cases of Brachial Plexus Birth Injury

“…A variety of subsequent studies, including a retrospective evaluation of 97 infants with a brachial plexus birth injury treated with only physical and occupational therapy, 4 suggest that while bicep recovery at 3 months is still a good prognostic marker, 8 the window of best opportunity for children with C5/C6±C7 injuries probably extends to at least 6 to 9 months of age, with a significant number of children showing a spontaneous recovery during the 3-to 6-month period that precludes the need for early operative intervention.…”

Nerve transfer versus muscle transfer to restore elbow flexion after pan–brachial plexus injury: a cost-effectiveness analysis

“…10,21 Adult patients with brachial plexus injury are disproportionately young males, with mean ages ranging from 25 to 29 years old, who can experience major disability and a lower quality of life after injury. OBJECTIVE Pan-brachial plexus injury (PBPI), involving C5-T1, disproportionately affects young males, causing lifelong disability and decreased quality of life.…”