Complications

Complication
Timeframe
Likelihood
long term
high

Recovery is incomplete in around 20% to 30% of children with brachial plexus birth injury.[49][108][163]​​ Shoulder dysfunction is the most common source of impairment, with the main problems related to weakness of external rotation, difficulty with overhead and at-the-head activities, and posterior shoulder subluxation/dislocation. Physiotherapy and occupational therapy, tendon transfers, or humeral osteotomy can successfully improve shoulder function.[22][56][130]

Elbow dysfunction typically relates to flexion contracture and difficulty with supination of the forearm. Flexion contractures can be improved with botulinum toxin type A injection with serial casting or surgical release but have a high recurrence rate.[118][122][151][152][157]​ Supination of the forearm is often the last function to recover in brachial plexus birth injury (BPBI) and can be considerably limited. Therapy focusing on this activity can produce good improvements in function.

Wrist and hand dysfunction usually accompany the most severe injuries and, as such, is challenging to treat. Most patients will have good hand and wrist function, but those who do not can be managed with nerve and tendon transfers to maximise wrist extension and finger grasp and release. Hand function in children with severe global palsies improves after surgery in 48% to 93%, depending on definition.[96]

The long-term ability to perform activities of daily living and general function is good for most patients despite these limitations.[110][167][168][169]

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