Recovery of the Total Birth Brachial Plexus Palsy without Surgical Treatment: A Single Center Retrospective Study and Literature Review

Abstract Background: Spontaneous recovery of a birth brachial plexus disorder is difficult to predict. Although root avulsion is strongly indicated for surgical management, early nerve surgery in non-root avulsion patients is still doubtful. This study aimed to report the recovery time of birth brachial plexus palsy who did not undergo surgery. Methods: In this retrospective study review, 75 patients with a mean follow-up time of 33.5 months, were included. Although patients met indications, surgical management was abandoned for various reasons. All infants were classified according to anatomical involvement and evaluated for clinical improvement by motor power grading. The recovery time was reported as the median and interquartile range. Results: Forty-five patients were initially diagnosed with total brachial plexus injury type. Thirty - seven patients had clinical evidence of recovering their hand motion in a median of 3 (IQR 2-5.5) months. The median time of recovery for elbow flexion and shoulder abduction was both 4 (IQR 3-6) months. The medians of antigravity or full motion recovery of shoulder abduction, elbow flexion, and hand flexion were 7.5 (IQR 5-16), 8 (IQR 5-17), and 7 (4-13) months, respectively. Conclusion: In this study, spontaneous recovery of shoulder, elbow and hand motion substantially occurred even in the patient initially diagnosed with a total birth brachial plexus palsy. True total plexus palsy can be distinguished from transient palsy by the recovery of hand motion at 3 months. Most of the shoulders and elbows of the patient, who had a spontaneous recovery, achieved antigravity movement without surgery.