The Journal of Bone and Joint Surgery (American). 2007;89:18-26.
doi:10.2106/JBJS.E.00430
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Long-Term Results of Surgery for Brachial Plexus Birth Palsy

Mikko Kirjavainen, MD1, Ville Remes, MD, PhD2, Jari Peltonen, MD, PhD2, Pentti Kinnunen, MD, PhD3, Tiina Pöyhiä, MD4, Timo Telaranta, MD, PhD5, Markku Alanen, MD, PhD6, Ilkka Helenius, MD, PhD2 and Yrjänä Nietosvaara, MD, PhD2

1 Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, PL 266, 0029 HUS, Finland. E-mail address: mikko.kirjavainen{at}hus.fi
2 Hospital for Children and Adolescents, Helsinki University Central Hospital, Stenbäckinkatu 11, PL 281, 00029 HUS, Finland
3 Hospital for Children, Oulu University Central Hospital, PL22, 90221 Oulu, Finland
4 Helsinki Medical Imaging Center, University of Helsinki, PL281, 00029 HUS, Finland
5 Privatix Hospital, PL 39, 33541 Tampere, Finland
6 Hospital for Children, Turku University Central Hospital, PL 52, 20521 Turku, Finland

Investigation performed at the Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland

Disclosure: In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Foundation for Pediatric Research, the Finnish Orthopedic Association, and the Finnish Hand Surgery Association. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

NOTE: R. Jauhola, C. Johansson, L. Malinen, P. Paavilainen, T. Peljo, H. Riikonen, M. Somervuori, K. Vanamo, and V. Vähäsarja participated in the gathering of the patients. S. Kuronen and S. Rautakorpi participated in the examinations of the patients. P. Burge participated in the revision of the manuscript.

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 multivariate analysis.

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 plexus injury.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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