Management of obstetric brachial plexus lesions: state of the art and future developments

Despite improving perinatal care the incidence of obstetric brachial plexus lesions (OBPL) has not declined., Most babies recover spontaneously. In 10 -20% recovery is incomplete. To prevent lasting functional deficits early r eferral to specialized centers is necessary. If the biceps shows no functio n at 3 months, standardized clinical assessment and additional investigatio ns must delineate the extent of a lesion. Detection of root avulsions by my elography and computed tomography combined with electrodiagnostics remains inconclusive in 15% of cases. Plexus reconstruction is performed during the 4th-6th months. Contractures or deformities are treated conservatively or by orthopedic surgery. Long-term rehabilitation is required., In future, as pects of prevention need attention. Improving imaging and neurophysiologica l techniques are promising for greater precision in detecting root avulsion s and even spontaneous recovering nerves. Functional imaging will allow bet ter understanding of central integration and plasticity. New pharmacologica l agents may promote nerve regeneration.