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The function of the hand after operations for obstetric injuries to the brachial plexus

M Kirjavainen1, V Remes, J Peltonen

  • 1Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Finland. mikko.kirjavainen@welho.com

The Journal of Bone and Joint Surgery. British Volume
|March 4, 2008
PubMed

Insights

Long-term outcomes for brachial plexus birth palsy surgery show varied hand function recovery. While stereognosis is often preserved, grip strength and sensation can be significantly impaired, especially with total brachial plexus injuries.

Area of Science:

  • Orthopedics
  • Pediatric Surgery
  • Neurology

Background:

  • Brachial plexus birth palsy (BPBP) is a common birth injury affecting arm function.
  • Surgical interventions in infancy aim to improve outcomes for BPBP patients.
  • Long-term functional assessment is crucial for understanding the efficacy of early surgical management.

Purpose of the Study:

  • To evaluate long-term hand function in patients operated on for brachial plexus birth palsy in infancy.
  • To correlate specific injury patterns and surgical outcomes with sensory and motor recovery.
  • To assess the effectiveness of early surgical intervention on fine sensation, stereognosis, grip strength, and overall hand function using the Raimondi scale.

Main Methods:

  • A cohort of 105 patients with BPBP, operated on in infancy, underwent long-term follow-up (mean 13.4 years).
  • Evaluations included fine sensation testing, stereognosis, grip and pinch strength measurements, and the Raimondi scale.
  • Sensory and motor function data were analyzed in relation to the specific brachial plexus root injury (C5-6, C5-7, total injury) and injury type (avulsion).

Main Results:

  • Fine sensation recovery varied by injury severity: 69% normal for C5-6, 48% for C5-7, and 32% for total injuries.
  • 11% of patients experienced loss or absence of protective sensation in parts of the hand.
  • Normal stereognosis was observed in 84% of patients, but only 9% had normal grip strength. Raimondi scale scores were highest for C5-6 injuries (mean 4.57) and lowest for total injuries (mean 2.16).
  • Impaired sensation correlated with injury location, and avulsion injuries were linked to poorer hand function recovery.

Conclusions:

  • Long-term follow-up reveals significant variability in hand function after early surgery for brachial plexus birth palsy.
  • While stereognosis is frequently preserved, grip strength and fine sensation recovery are often compromised, particularly in severe or total brachial plexus injuries.
  • Avulsion injuries represent a significant risk factor for poor functional recovery, highlighting the need for targeted management strategies.

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