Evaluation of elbow flexion as a predictor of outcome in obstetrical brachial plexus palsy.
BACKGROUND
The purpose of this study was to answer two questions. First, are there obstetrical brachial plexus palsy patients with no elbow flexion at 3 months who go on to recover useful upper extremity function without surgical intervention? Second, are there patients with evidence of elbow flexion at 3 months who do benefit from brachial plexus reconstruction?


METHODS
The authors retrospectively reviewed a sample drawn from 253 consecutive patients at The Hospital for Sick Children obstetrical brachial plexus database from 1993 to 1996. Inclusion criteria were examination at age 3 months and either complete spontaneous recovery or repeated examination after age 3 years. Two hundred nine patients satisfied the inclusion criteria. Patients were distributed into four groups: group A, no elbow flexion at age 3 months (operative management); group B, elbow flexion present at 3 months (operative management); group C, no elbow flexion at age 3 months (nonoperative management); and group D, elbow flexion present at 3 months (nonoperative management).


RESULTS
Groups A, B, and C showed significant intragroup improvements in both elbow flexion (p < 0.0001) and total limb motion scores (the sum of 15 individual joint motions) (p < 0.0001) with time. No differences were noted among groups A, B, and C for either elbow flexion or total limb motion scores at final follow-up.


CONCLUSIONS
Early elbow flexion alone is not a sufficient criterion to recommend a nonoperative approach. In addition, spontaneous recovery of useful upper extremity function has been observed in a carefully selected subset of patients without elbow flexion at 3 months.
Toronto, Ontario, Canada From the Division of Plastic Surgery and Division of Physiotherapy, Department of Rehabilitation Services, The Hospital for Sick Children, and Department of Surgery, University of Toronto.
David M
DM
Fisher
Gregory H
GH
Borschel
Christine G
CG
Curtis
Howard M
HM
Clarke
D001720:Birth Injuries / Q000503:physiopathology*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology*; D002675:Child, Preschool; D004551:Elbow Joint / Q000502:physiology*; D006801:Humans; D007223:Infant; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D012189:Retrospective Studies