Waters brachial plexus birth palsy

Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy

Waters PM The Journal of bone and joint surgery. American volume 1999 · PMID 10360693 · doi:10.2106/00004623-199905000-00006

Question

Does timing of biceps recovery predict outcome in brachial plexus birth palsy, and when is microsurgery better than observation?

Design

Cohort study documenting natural history by month of biceps recovery, with outcomes after microsurgery and after secondary shoulder reconstruction.

Patients

Infants with brachial plexus birth palsy seen before three months of age, plus older children referred with chronic deficits.

Intervention

Microsurgical plexus repair for infants without biceps recovery by six months; latissimus dorsi/teres major transfer or humeral derotation osteotomy for older children

Comparison

Natural history according to timing of biceps recovery

Primary outcome

Shoulder function on the modified Mallet score

Key result

Infants whose biceps recovered within the first three months achieved normal function, whereas recovery in the fourth to sixth months was followed by significantly worse Mallet scores; this supported microsurgical repair for infants with no biceps recovery by six months.

Limitations

Non-randomised single-surgeon series with small surgical groups and treatment allocated by clinical course.

Impact on practice

Underpins the widely used rule of referring infants without biceps recovery by 3 months to a specialist brachial plexus unit and considering microsurgery by about 6 months.