Function of the upper limb after surgery for obstetric brachial plexus palsy

We reviewed a consecutive series of 33 infants who underwent surgery for ob stetric brachial plexus palsy at a mean age of 4.7 months. Of these, 13 wit h an upper palsy and 20 with a total palsy were treated by nerve reconstruc tion. Ten were treated by muscle transfer to the shoulder or elbow, and 16 by tendon transfer to the hand. The mean postoperative follow-up was 4 year s 8 months. Ten of the 13 children (70%) with an upper palsy regained usefu l shoulder function and 11 (75%) useful elbow function. Of the 20 children with a total palsy, four (20%) regained useful shoulder function and seven (35%) useful elbow function. Most patients with a total palsy had satisfact ory sensation of the hand, but only those with some preoperative hand movem ent regained satisfactory grasp. The ability to incorporate the palsied arm and hand into a co-ordinated movement pattern correlated with the sensatio n and prehension of the hand, but not with shoulder and elbow function.