Advances in intraoperative neuroelectrodiagnostic testing and microneurosurgical techniques have made it possible to accurately explore the brachial plexus of neonates. Since 1987, we have followed 250 infants with birth-related brachial plexus injuries, and successful operations have been completed on more than 70 infants. Fifty infants who underwent surgery have been followed for more than 18 months. Based on these accumulated data and historical data, this review describes both nonoperative and operative approaches to the treatment of birth-related brachial plexus injuries.

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Obstetrical brachial plexus injuries are reported in the medical literature at a rate of 0.38 to 2.6 per thousand live births. Historically, the management of these lesions has been conservative, with observation and physical therapy as the primary modalities of treatment. However, experience has shown that a small majority of these devastating lesions have required more direct and invasive approaches. The experience gathered over a 15-year time span of managing these cervical nerve injuries has afforded the Texas Children's Hospital Brachial Plexus team the opportunity to come to several conclusions regarding the global treatment of these patients. The first is that diagnosis, observation, and therapy are the initial approaches to these injuries and should be initiated immediately. Second, early surgical intervention is essential to maximizing the long-term improvements in select patients by helping to prevent residual growth deformities and underdevelopment of the affected limbs. Third, the development of secondary residual deformities must be addressed with secondary reconstructive procedures to arrest the underdevelopment of affected limbs. These goals of reconstruction have been implemented over a period of 15 years and have been shown to provide marked improvements in the functionality and quality of life in patients affected with these physically disabling lesions.

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