Brachial Plexus Palsy Management Clinical Pathway

Pathway Background and Objectives

Brachial plexus palsies occur in about one in 1000 live births. Older literature quotes over 90% rate of recovery, however “recovery” has a broad definition that includes any reanimation of the limb. Recognizing secondary weakness and deformity, the actual recovery rate is closer to 66%, with 15% experiencing significant permanent weakness. Prompt diagnosis, examination for associated pathology, and early referral to a specialty clinic can optimize outcomes and family satisfaction. The objectives of this pathway are to:

  • Ensure prompt diagnosis of brachial plexus palsy
  • Ensure early referral to brachial plexus clinic for Orthopedic and Neurosurgical evaluation
  • Initiate early motion exercises and therapy to optimize motion and recovery

Algorithm  Educational Module 

 
For management of this condition in primary care, see CLASP/Co-Management guideline

  • Percentage of patients with spontaneous recovery by 12 months of age
  • Percentage of operative patients (cable graft or neurontization) with recovery of antigravity motor function in biceps by 1 year post-op
  1. Abzug JM, Kozin SH. Evaluation and management of brachial plexus birth palsy. Orthop Clin North Am. 2014 Apr;45(2):225-32.
  2. Chung KC, Yang LJS, McGillicuddy J. (2011). Practical Management of Pediatric and Adult Brachial Plexus Palsies. New York: Saunders.
  3. Gilbert A. (2001). Brachial Plexus Injuries. London: Martin Dunitz Ltd.
  4. Pearl ML. Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg. 2009 Apr;17(4):242-54.
  • Sonia Chaudhry, MD (Orthopedic Surgery)
  • Jonathan Martin, MD (Neurosurgery)

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.