Purpose
The role of primary surgery in delayed presenting cases of brachial plexus birth injury
is still debated. The purpose of this study was to evaluate the results of brachial
plexus reconstruction performed at the age of ≥12 months.
Methods
Twenty-nine cases were included. Five cases had upper (C5–6) palsy, 4 had upper/middle
(C5–7), and 20 had total (C5–8 and T1) palsy.
Results
The age at the time of primary surgery was an average of 15.6 months. The brachial
plexus was formally explored and neurolysis, grafting, and neurotization were used
in different combinations. Exploration revealed that 27% of the roots were avulsed
and 32% were ruptured. The follow-up was an average of 7.9 years. Generally, the best
functional recovery was elbow flexion followed by shoulder external rotation. Satisfactory
shoulder abduction (≥6 on the Toronto Active Movement Scale [TAMS]) was achieved in
31% of cases. The abduction range was an average of 79° ± 35°; 50° in upper palsy,
103° in upper/middle palsy, and 82° in total palsy. Shoulder external rotation ≥6
on the TAMS was achieved in 62% of cases. External rotation range was an average of
58° ± 29°; 78° in upper palsy, 68° in upper/middle palsy, and 52° in total palsy.
Elbow flexion and extension of ≥6 on the TAMS were achieved in 69% and 58% of cases,
respectively. Wrist flexion and finger flexion of ≥6 on the TAMS were achieved in
35% and 12.5%, whereas wrist and finger extension of >6 on the TAMS were achieved
in 25% and 4% of cases, respectively.
Conclusion
In the delayed presentation of brachial plexus birth injury, brachial plexus reconstruction
results in good functional recovery of elbow flexion and shoulder external rotation
but modest functional recovery of finger flexion and wrist extension. The rate of
functional recovery of the elbow flexion was similar following nerve grafting and
transfer. Nerve transfer for shoulder external rotation should be considered even
in infants with available roots for grafting.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: December 18, 2022
Accepted:
November 9,
2022
Received in revised form:
October 22,
2022
Received:
April 24,
2022
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand.
