title: Extending the indications for primary nerve surgery in obstetrical brachial plexus palsy.
abstract: OBJECTIVE
  This study identifies a small subset of patients with obstetrical brachial plexus palsy who, while they do not meet common surgical indications, may still benefit from primary nerve surgery.
  
  
  METHODS
  Between April 2004 and April 2009, 17 patients were offered primary nerve surgery despite not meeting the standard surgical indications of the authors. The authors performed a retrospective analysis of these 17 patients using prospectively collected data.
  
  
  RESULTS
  This group of 17 patients were identified as having poor shoulder function at about 9 months of age despite passing the Cookie Test. Fourteen patients underwent surgical intervention and three families declined surgery. All patients in the operative group regained some active external rotation after surgery. Five patients in this group have required further interventions. Two of the three patients for whom surgery was declined have had no subsequent spontaneous improvement in active external rotation.
  
  
  CONCLUSIONS
  The commonly used indications for primary nerve surgery in obstetrical brachial plexus palsy may not adequately identify all patients who may benefit from surgical intervention. Patients who pass the Cookie Test but have poor spontaneous recovery of active shoulder movements, particularly external rotation, may still benefit from primary nerve surgery.
authors: Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8 ; Royal Children's Hospital, Herston Road, Herston, Brisbane, QLD 4029, Australia.
authors: Stuart A
authors: SA
authors: Bade
authors: Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8 ; University of Montreal, Montreal, QC, Canada H3T 1C5.
authors: Jenny C
authors: JC
authors: Lin
authors: Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8.
authors: Christine G
authors: CG
authors: Curtis
authors: Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8 ; Department of Surgery, University of Toronto, Toronto, ON, Canada M5T 1P5.
authors: Howard M
authors: HM
authors: Clarke
mesh_terms: D001720:Birth Injuries / Q000453:epidemiology / Q000601:surgery*; D001917:Brachial Plexus / Q000293:injuries / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013647:Task Performance and Analysis