Abduction is one of the important shoulder functions that may be limited after an obstetric brachial plexus injury. We investigated the progress of spontaneous recovery of active abduction in a cohort of 68 conservatively treated obstetric brachial plexus injury patients without full recovery and with less than 90° abduction at 3 months. Of these 65 (96%) recovered at least 90° and 32 (47%) a full 170° of abduction. The median age of recovery to 90° was 9 months (IQR 7–12, range 5–65 and to 170° 24 months (IQR 12–36, range 5–84). The presence of active antigravity elbow flexion ≥90° at 4 months was not associated with recovery of abduction. The results suggest that most obstetric brachial plexus injury patients with isolated absent or slowly recovering shoulder movements recover at least 90° of abduction. In patients with absent or weak abduction, and otherwise satisfactory spontaneous recovery, surgical interventions should not be considered before 1 year of age.
AbdelmaksoudIMAhmadMHSemayaAEAhmedAR.The effect of distal transfer of the spinal accessory nerve to the suprascapular nerve on the shoulder reanimation in spontaneously partially recovered obstetric brachial plexus lesion. Ann Plast Surg. 2020,
85: 402–6.
CoveyDCRiordanDCMilsteadMEAlbrightJA.Modification of the L’Episcopo procedure for brachial plexus birth palsies. J Bone Joint Surg Br. 1992,
74: 897–901.
4.
CurtisCStephensDClarkeHMAndrewsD.The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg Am. 2002,
27: 470–8.
5.
DeFrancescoCJShahDKRogersBHShahAS.The epidemiology of brachial plexus birth palsy in the United States: declining incidence and evolving risk factors. J Pediatr Orthop. 2019,
39: e134–40.
6.
FoadSLMehlmanCTFoadMBLippertWC.Prognosis following neonatal brachial plexus palsy: an evidence-based review. J Child Orthop. 2009,
3: 459–63.
7.
GrahnPSommarhemANietosvaaraY.A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study. J Hand Surg Eur. 2022,
47: 248–56.
8.
HikFAcklandDC.The moment arms of the muscles spanning the glenohumeral joint: a systematic review. J Anat. 2019,
234: 1–15.
9.
HoeksmaAFter SteegAMNelissenRGHHvan OuwerkerkWJRLankhorstGJde JongBA.Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol. 2004,
46: 76–83.
10.
HughesREAnKN.Force analysis of rotator cuff muscles. Clin Orthop. 1996: 75–83.
11.
HyttinenMRönkköHPaavilainenPHelminenMJokihaaraJ.Spontaneous recovery of active shoulder external rotation in patients with brachial plexus birth injury. Plast Reconstr Surg. 2024.
12.
JohanssonAUvebrantPLagerkvistAL.Obstetric brachial plexus palsy – a prospective, population-based study of incidence, recovery and long-term residual impairment at 10 to 12 years of age. Eur J Paediatr Neurol. 2019,
23(1): 87–93.
13.
LeechavengvongsSWitoonchartKUerpairojkitCThuvasethakulP.Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg. 2003,
28: 633–8.
14.
MichelowBJClarkeHMCurtisCGZukerRMSeifuYAndrewsDF.The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg. 1994,
93: 675–80; discussion 681.
15.
MollbergMLadforsLVStrömbeckCEldenHLadforsL.Increased incidence of shoulder dystocia but a declining incidence of obstetric brachial plexus palsy in vaginally delivered infants. Acta Obstet Gynecol Scand. 2023,
102: 76–81.
16.
OberlinCBéalDLeechavengvongsSSalonADaugeMCSarcyJJ.Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg. 1994,
19: 232–7.
17.
van OuwerkerkWJRUitdehaagBMJStrijersRLM, et al.
Accessory nerve to suprascapular nerve transfer to restore shoulder exorotation in otherwise spontaneously recovered obstetric brachial plexus lesions. Neurosurgery. 2006,
59: 858.
18.
PhippsGJHofferMM.Latissimus dorsi and teres major transfer to rotator cuff for Erb’s palsy. J Shoulder Elbow Surg. 1995,
4: 124–9.
19.
PondaagWMalessyMJAvan DijkJGThomeerRTWM.Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004,
46: 138–44.
20.
PondaagWde BoerRvan Wijlen-HempelMSHofstede-BuitenhuisSMMalessyMJA.External rotation as a result of suprascapular nerve neurotization in obstetric brachial plexus lesions. Neurosurgery. 2005,
57: 530–7.
21.
SegalDCornwallRLittleKJ.Outcomes of spinal accessory-to-suprascapular nerve transfers for brachial plexus birth injury. J Hand Surg Am. 2019,
44: 578–87.
22.
SeruyaMShenSHFuzzardSCoombsCJMcCombeDBJohnstoneBR.Spinal accessory nerve transfer outperforms cervical root grafting for suprascapular nerve reconstruction in neonatal brachial plexus palsy. Plast Reconstr Surg. 2015,
135: 1431–8.
23.
SmithNCRowanPBensonLJEzakiMCarterPR.Neonatal brachial plexus palsy. Outcome of absent biceps function at three months of age. J Bone Joint Surg Am. 2004,
86: 2163–70.
24.
SommarhemAJGrahnPMNietosvaaraYA.Selective neurotization of the infraspinatus muscle in brachial plexus birth injury patients using the accessory nerve. Plast Reconst Surg. 2015,
136: 1235–8.
25.
ThatteMRMehtaR.Obstetric brachial plexus injury. Indian J Plast Surg Off Publ Assoc Plast Surg India. 2011,
44: 380–9.
26.
TorodeIDonnanL.Posterior dislocation of the humeral head in association with obstetric paralysis. J Pediatr Orthop. 1998,
18: 611–5.
27.
WatersPM.Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am. 1999,
81: 649–59.
28.
WatersPMSmithGRJaramilloD.Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am. 1998,
80: 668–77.
29.
WickhamJPizzariTStansfeldKBurnsideAWatsonL.Quantifying “normal” shoulder muscle activity during abduction. J Electromyogr Kinesiol Off J Int Soc Electrophysiol Kinesiol. 2010,
20: 212–22.
