Background: The long-term results of surgical treatment of brachial
plexus birth palsy have not been reported. We present the findings of a
nationwide study, with a minimum five-year follow-up, of the outcomes of
surgery for brachial plexus birth palsy in Finland.
Methods: Of 1,717,057 newborns, 1706 with brachial plexus birth
palsy requiring hospital treatment were registered in Finland between 1971 and
1997. Of these patients, 124 (7.3%) underwent surgery on the brachial plexus
at a mean age of 2.8 months (range, 0.4 to 13.2 months). The most commonly
performed surgical procedure was direct neurorrhaphy after neuroma resection.
One hundred and twelve patients (90%) returned for a clinical and radiographic
follow-up examination after a mean of 13.3 years. Activities of daily living
were recorded on a questionnaire, and the affected limb was assessed with use
of joint-specific functional measures.
Results: Two-thirds (63%) of the patients were satisfied with the
functional outcome, although one-third of all patients needed help in
activities of daily living. One-third of the patients, including all nine with
a clavicular nonunion from the surgical approach, experienced pain in the
affected limb. All except four patients used the hand of the unaffected limb
as the dominant hand. Shoulder function was moderate, with a mean Mallet score
of 3.0. Both elbow and hand function were good, with a mean score on the
Gilbert elbow scale of 3 and a mean Raimondi hand score of 4. Incongruence of
the glenohumeral joint was noted in sixteen (16%) of the ninety-nine patients
in whom it was assessed, and incongruence of the radiohumeral joint was noted
in twenty-one (21%). The extent of the brachial plexus injury was found to be
strongly associated with the final shoulder, elbow, and hand function in a
Conclusions: Following surgical treatment of brachial plexus birth
palsy, substantial numbers of the patients continued to need help performing
activities of daily living and had pain in the affected limb, with the pain
due to a clavicular nonunion in one-fourth of the patients. The strongest
prognostic factor predicting outcome appears to be the extent of the primary
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.