Pediatric Brachial Plexus Palsy

The incidence and severity of brachial plexus palsy have been minimized by modern obstetric care. Despite these improvements, the occurrence of brachial plexus palsy has not been eliminated. A brachial plexus injury or palsy results when the nerve roots and/or nerves of the brachial plexus are stretched, torn, or compressed. Factors that contribute to the difficult passage of a fetus through the birth canal are associated with brachial plexus injuries. Brachial plexus palsy is typically noticed at the time of birth when the newborn has decreased spontaneous motion of the affected arm. Careful serial examinations will enable the examiner to determine the pattern of muscular impairment and thus enable conclusions about the locus, or loci, of injury within the brachial plexus. Most es of brachial plexus palsy are transient and resolve naturally by 3–4 months of age. If significant deficits persist after this time, microsurgery to repair or reconstruct the injured nerves may be considered. If there is biceps antigravity function by 6 months of age, microsurgery is not beneficial and should not be performed. This latter group of patients is better served by ongoing physical therapy, occupational therapy, and consideration for musculoskeletal surgery after 18 months of age.