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Timing of Recovery of Shoulder Function in Brachial Plexus Birth Palsy
Shriners Hospital for Children, Philadelphia, PA, USA
Dan Zlotolow, MD; Joseph Ferguson; Scott Kozin
We retrospectively reviewed 74 consecutive patients with adequate documentation seen in our clinic for brachial plexus birth palsy. Timing to recovery was measured either from the time of injury (birth) or the date of microsurgery (at approximately 6 months of age) if performed. There were 45 females and 29 males, with the right side affected in 61%, weighing an average of 3.8 Kg, with an average follow-up of 24 months. Recovery of Active Movement Scale (AMS) grade 6 or 7 was found in 57% of patients for abduction at an average of 20 months, in 31% of patients for forward flexion at an average of 18 months, in 31% of patients for external rotation at an average of 19 months, and in 83% of patients for elbow flexion at an average of 11 months. Of the 9 patients who had a spinal accessory to suprascapular nerve transfer, 22% recovered abduction and forward flexion at an average of 24.5 months, 22% recovered external rotation at an average of 15.5 months, and 56% recovered elbow flexion at an average of 10 months. Of the 17 patients that underwent nerve grafting, 29% recovered abduction and forward flexion at an average of 18 months, 12% recovered external rotation at an average of 9 months and 59% recovered elbow flexion at an average of 13.3 months. For the global injuries, 50% of patients recovered biceps flexion at an average of 18.7 months. No recovery was seen for the 6 cases of global injuries in terms of shoulder abduction, forward flexion, or external rotation. Extended Erb’s palsy patients (n=18) experienced a 22% recovery rate for abduction (average 22.5 months), a 28% recovery rate for flexion (average 19.2 months), a 22% recovery rate for external rotation (average 17.8 months), and a 83% recovery rate for elbow flexion (average 10.6 months). Patients with Erb’s palsies recovered abduction at a rate of 80% in an average of 26.9 months, flexion at a rate of 38% in an average of 16.8 months, external rotation at a rate of 42% in an average of 18.8 months, supination at a rate of 33% in an average of 19.1 months, and elbow flexion at a rate of 98% in an average of 10.6 months. Given the timing of recovery, we recommend delaying tendon transfer surgery until about 2 years of age to allow maximal spontaneous neurologic recovery to occur.
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