Birth Brachial Plexus Palsy

Birth brachial plexus palsy (BBPP) injury occurs in approximately 1 to 2/1,000 live births. This number has not changed significantly over the years. In most infants, clinical symptoms eventually resolve. As reported in the literature, between 50 and 95% of affected infants will recover. In this chapter, we review risk factors and describe the anatomy involved. We also discuss the clinical evaluation and describe treatment approaches. Plain radiography and electrodiagnosis, including nerve conduction studies and electromyography, may be useful in clinical decisionmaking. Early treatment and immediate education of the family are essential. For a child with a flaccid, anesthetic arm, surgery is typically performed when he or she is 3 or 4 months old. If the child is capable of some arm movement, surgery is usually done when he or she is 6 to 9 months of age. Surgical intervention with nerve grafting has been available for more than 100 years. A multitude of muscle and tendon procedures also exist. In addition, more traditional orthopedic procedures, such as arthrodesis and derotational osteotomies, may be undertaken.