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Surgery for Brachial Plexus Injuries
Early Operative Intervention for Birth Injuries to the Brachial Plexus. Grossman JA, Seminars in Pediatric Neurology 2000, 7:36- 43.
Early surgical repair is indicated for selected infants who sustain birth trauma to the brachial plexus. In children with global or total paralysis surgery should be performed by 3-4 months of age to maximize ultimate extremity function. Although the timing of surgery for Erb’s palsy remains controversial, in properly selected cases nerve reconstruction leads to an improvement in shoulder function and overall limb function.
Comment: Neonatal health care professionals are typically more involved with the early diagnostic evaluation of babies with obstetric brachial plexus palsies than with the later therapeutic interventions for these injuries. We also advise our pediatric colleagues about the timing of further evaluation and treatment if the arm weakness persists. It is therefore useful to keep abreast of the recent advances in treatment of this disorder. To that end, I highly recommend reading this entire issue of Seminars in Pediatric Neurology (Vol 7, Number 1, March 2000) which is devoted to the surgical management of brachial plexus injuries. At least, be aware that several centers are now reporting very encouraging results with nerve grafting and extraplexal nerve transfers for brachial plexus injuries. The author of this paper, Dr. John Grossman, is affiliated with the Brachial Plexus and Peripheral Nerve Surgery Program at Miami Children’s Hospital.
Andrew B. Kairalla MD