Long-Term Results of Surgery for Brachial Plexus Birth Palsy

Author(s): Kirjavainen M, Remes V, Peltonen J, et al.

Source: J Bone and Joint Surg 89-A (1): 18-26, 2007.

Summary:

This nationwide study from Finland reviews the long-term results at a minimum of 5 year follow-up of 112 patients that underwent surgical treatment for obstetrical brachial plexus palsy.  There was a 90% follow up at a mean of 13 years.  The unaffected limb was dominant in 96% of the patients.  Thirty-one percent had pain in the affected upper limb but 25% of those had a clavicular nonunion.  Thirty-five percent of these patients required help with activities of daily living with main problems being washing hair, cutting food and buttoning a shirt.  The mean Mallet score for shoulder function was 3.0 (range, 2-4).  There was significantly diminished Mallet scores for patients with a total palsy.  Fifty-five percent were unable to externally rotate their arm past 0 degrees.  Twelve percent of patients had either posterior subluxation or  dislocation of the glenohumeral joint.  Elbow function was significantly affected by the congruency of the radiohumeral joint.  Twenty-one percent of patients either had a subluxated or dislocated radiohumeral joint.  Hand function was impaired in 31% of patients without a previously undiagnosed C-8 nerve root lesion.  Overall, upper extremity function was significantly impaired in patients with total plexus involvement but was not significant different between those with a C5-6 versus C-5-7 injury. 

This study confirms that patients with obstetrical brachial plexus palsies will likely have significant permanent disabilities despite undergoing surgical treatment.  The majority of patients will choose the unaffected hand for dominant use and one-third of the patients will require help with activities of daily living and have occasional or daily pain.  The most important prognostic factor for the prediction of final outcome is the extent of the brachial plexus injury.


Brachial, Plexus, Palsy, Reconstruction, Function, Birth


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