Perinatal brachial plexus palsy (PBPP) has been traditionally classified into three types: upper plexus palsy (Erb's) affecting the C5, C6, and ± C7 nerve roots, lower plexus palsy (Klumpke's) affecting the C8 and T1 nerve roots, and total plexus palsy. Although most cases will resolve spontaneously, the natural history of the remaining cases is influenced by contractures of uninvolved muscle groups and subluxation or dislocation of the shoulder and elbow. Microsurgical nerve repair has demonstrated to provide improved outcomes compared to conservative treatment, while advancements in secondary reconstruction have offered significant improvements in the performance of activities of daily living for older children with unresolved plexus palsy.
Abbreviations:MRI magnetic resonance imaging, PBPP perinatal brachial plexus palsy
Over the past 4 decades, the physician's approach to brachial plexus injuries has changed dramatically. Traditional techniques had focused on muscle or tendon transfers to reconstruct the paralyzed limb. With the advent of microsurgical techniques, reconstructive options have shifted the focus onto primary nerve repair or nerve transfer to reinnervate paralyzed muscles. The literature is replete with case reports, clinical trials, and review articles on the successes of microsurgical nerve repair. Nerve repair, nerve grafting, and nerve transfer are now widely accepted techniques, each with its own indications. The treatment of perinatal brachial plexus palsy has been revolutionized through the application of microsurgical reconstruction.