THE NATURAL-HISTORY OF OBSTETRICAL BRACHIAL-PLEXUS PALSY

Obstetrical brachial plexus palsy remains an unfortunate consequence o f difficult childbirth. Sixty-six such patients were reviewed. Include d were 28 patients (42 percent) with upper plexus involvement and 38 ( 58 percent) with total plexopathy. The natural history of spontaneous recovery in all of these patients has been determined using an appropr iate grading mechanism. Sixty-one patients (92 percent) recovered spon taneously and five patients (8 percent) required primary brachial plex us exploration and reconstruction (median age 12 months), demonstratin g that most patients do well. Additional analysis was undertaken to ex amine ways in which outcome might be predicted. The analysis does not consider whether or not the patient was operated upon. Good or poor re covery was determined by the spontaneous recovery observed. Discrimina nt analysis revealed that whereas elbow flexion at 3 months correlated well with spontaneous recovery at 12 months, when used as a single pa rameter it incorrectly predicted recovery in 12.8 percent of cases. Sh oulder abduction was not a significant predictor of recovery. Numerous other early parameters correlated well with spontaneous recovery. Whe n elbow flexion and elbow wrist, thumb, and finger extension at 3 mont hs were combined into a test score, the proportion of patients whose r ecovery was incorrectly predicted was reduced to 5.2 percent.