Brachial Plexus Palsy Management

Pathway Background and Objectives

Brachial plexus palsies occur in about one in 1000 live births. Older literature quotes over 90% rate of recovery, however “recovery” has a broad definition that includes any reanimation of the limb. Recognizing secondary weakness and deformity, the actual recovery rate is closer to 66%, with 15% experiencing significant permanent weakness. Prompt diagnosis, examination for associated pathology, and early referral to a specialty clinic can optimize outcomes and family satisfaction.  The objectives of this pathway are to:

  • Ensure prompt diagnosis of brachial plexus palsy
  • Ensure early referral to brachial plexus clinic for Orthopedic and Neurosurgical evaluation
  • Initiate early motion exercises and therapy to optimize motion and recovery

Algorithm

Download the Brachial Plexus Palsy Management Pathway Algorithm

For management of this condition in primary care, see CLASP/Co-Management guideline

Quality Metrics

  • Percentage of patients with spontaneous recovery by 12 months of age
  • Percentage of operative patients (cable graft or neurontization) with recovery of antigravity motor function in biceps by 1 year post-op

Educational Module

Download the Brachial Plexus Palsy Management Education Module

Key References

  1. Abzug JM, Kozin SH. Evaluation and management of brachial plexus birth palsy. Orthop Clin North Am. 2014 Apr;45(2):225-32.
  2. Chung KC, Yang LJS, McGillicuddy J. (2011). Practical Management of Pediatric and Adult Brachial Plexus Palsies. New York: Saunders.
  3. Gilbert A. (2001). Brachial Plexus Injuries. London: Martin Dunitz Ltd.
  4. Pearl ML. Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg. 2009 Apr;17(4):242-54.

Pathway Contacts

  • Sonia Chaudhry, MD (Orthopedic Surgery)
  • Jonathan Martin, MD (Neurosurgery)

 

 

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