Management and Treatment of Brachial Plexus Birth Palsy

Brachial plexus birth palsy arises from traction or compression of the neonatal brachial plexus during delivery, leading to varying degrees of motor and sensory impairment in the upper limb. Lesions range from mild neurapraxia, with spontaneous recovery in the first months of life, to severe root avulsions requiring surgical intervention. Early clinical assessment of shoulder and elbow function guides decision-making, supported by imaging modalities such as high-resolution MRI and ultrasound to localise preganglionic and postganglionic injuries. Conservative management comprises physiotherapy, occupational therapy and adjuncts such as electrostimulation or orthotic splinting, with primary nerve reconstruction indicated when spontaneous recovery is absent or delayed beyond three months. Secondary corrective procedures—including tendon transfers and joint releases—address persistent functional deficits or deformities. Standardised outcome measures, notably the Mallet score, facilitate comparison across centres. Emerging research targets molecular pathways of muscle contracture and novel rehabilitation technologies, highlighting the importance of a multidisciplinary approach to optimise long-term function and quality of life.

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Management and Treatment of Brachial Plexus Birth Palsy publication trend

The graph below shows the total number of articles in management and treatment of brachial plexus birth palsy across all publications each year (not limited to Nature Index journals).

Technical terms

Obstetric brachial plexus palsy: Injury to the brachial plexus sustained during childbirth, resulting in upper-limb motor and sensory deficits.

Nerve root avulsion: Complete tearing of a spinal nerve from the spinal cord, often requiring surgical reconstruction.

Conservative treatment: Non-surgical management including physiotherapy, occupational therapy and supportive modalities.

Primary nerve reconstruction: Early surgical repair or grafting of avulsed or ruptured nerves to restore continuity and function.

Mallet score: A clinical grading system for shoulder function in children with brachial plexus injury, assessing global arm movements.

References

1. Virtual Reality for Upper Limb Rehabilitation in Patients With Obstetric Brachial Palsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Medical Internet Research (2023).
2. The role of sympathetic innervation in neonatal muscle growth and neuromuscular contractures. The FEBS Journal (2023).
3. High-Resolution MRI Evaluation of Neonatal Brachial Plexus Palsy: A Promising Alternative to Traditional CT Myelography. American Journal of Neuroradiology (2013).
4. Brachial Plexus Ultrasound and MRI in Children with Brachial Plexus Birth Injury. American Journal of Neuroradiology (2018).
5. Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world‐wide consensus survey. Journal of Orthopaedic Research® (2018).
6. Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review. Journal of Clinical Medicine (2019).
7. Extending the Indications for Primary Nerve Surgery in Obstetrical Brachial Plexus Palsy. BioMed Research International (2014).
8. Prognosis following neonatal brachial plexus palsy: An evidence-based review. Journal of Children's Orthopaedics (2009).