Management of Obstetrical Brachial Plexus Palsy: The Stanford Experience

Abstract

Stanford's experience in the management of obstetrical brachial plexus palsy dates from 1983. A formal clinic service began in 1992. The tenets of management include early evaluations, a dependence on sequential evolution for decision making, and very early neural surgery for babies with abnormal hands. We watch babies with normal hands for a longer time before advising surgery. Intraoperative evoked potentials are used to make surgical decisions. Reconstructive goals for upper plexus injuries include shoulder and elbow control. The paramount goal for babies with global palsies is hand function. Therapy throughout the child's growth years is vital. Sequelae, particularly shoulder contractures, require early surgical intervention. Secondary reconstructive procedures are typically beneficial in improving function. Since 1992, more than 400 children have been examined; 62 have had neural reconstruction and 102 have undergone secondary procedures. Surgery has been remarkably complication free. All children having neural reconstruction except two have benefited.