Management of birth brachial plexus palsy.
BACKGROUND
The indications for surgical repair of congenital brachial plexus palsy are controversial. Our objective was to determine the results of early brachial plexus surgery following obstetric-induced brachial plexus palsy.


METHODS
We performed a retrospective analysis of the outcome of 58 cases of brachial plexus surgery. The indication for operation consisted of the presence of less than antigravity strength in the biceps, triceps, and deltoid muscle groups at 6 months of age. Data gathered prospectively, previously, showed the likelihood of improvement with less than antigravity strength in these cases to be poor.


RESULTS
Follow-up data were obtained on 52 of the 58 cases. Overall mean follow-up was 2 years. Twelve patients had more than 3 years follow-up (mean 5.5 years, range 3-11.5 years). Significant improvement was seen in all injury patterns i.e., C5-C6, C5-C7, and C5-C8, T1. Greater than antigravity strength in the biceps, triceps, and deltoid muscle groups was seen in the majority of cases at follow-up.


CONCLUSIONS
Repair of obstetrical brachial plexus palsy in children at 6 months of age that is based on less than antigravity strength in the biceps, triceps, and deltoid muscle groups produces improvement in functional capabilities. Children with obstetrical brachial plexus palsy should be referred soon after birth to a center that specializes in the treatment of this type of palsy.
O'Brien
Donncha F
DF
Department of Neurosurgery, St. Louis Children's Hospital, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
Park
T S
TS
Noetzel
Michael J
MJ
Weatherly
Trisha
T
D020516:Brachial Plexus Neuropathies / Q000473:pathology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015201:Meta-Analysis as Topic; D008866:Microsurgery; D012189:Retrospective Studies; D016896:Treatment Outcome