Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

Abstract

An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good.

Navigating the gray zone: a guideline for surgical decision making in obstetrical brachial plexus injuries

“…The AMS score alone is not enough to evaluate recovery outcomes in the toddler and child but does work very well as early evidence of recovery in the young infant. In keeping with Hoeksma et al, 14 Bisinella and Birch, 3 and Waters, 21 our GZ guideline also places strong emphasis on the assessment of shoulder function. These authors have made a strong case that if recovery of shoulder as well as biceps function is not present by 1 month of age then there is a significant risk of incomplete recovery.…”

“…Other groups have also demonstrated similar findings. 14,19,21 It is imperative that families be informed that incomplete recovery by 5-6 months equates with incomplete recovery in the future. The GZ ends at 6 months, suggesting that the decision for surgery should be clear by then.…”

Bone Discrepancy as a Powerful Indicator for early Surgery in Obstetric Brachial Plexus Palsy

“…Despite some conflicting reports [2,17,21], probably more than 70% of all infants presenting with OBPP will have a very good spontaneous recovery. The remaining patients are destined for poor functional outcomes and they are potential candidates for nerve surgery.…”

The Prevalence, Rate of Progression, and Treatment of Elbow Flexion Contracture in Children with Brachial Plexus Birth Palsy

“…Although full recovery has been reported in up to 92% of cases 6 , recent studies have reported more modest recovery rates of 66% to 80% 7,8 . Children whose neurological deficit does not resolve may experience softtissue contractures and osseous deformities that can significantly impair upper-extremity function and appearance [9][10][11][12] .…”