Related Experiment Video
Updated: Jun 1, 2026
Development of a Neonatal Rat Model for Brachial Plexus Birth Injury
Published on: March 27, 2026
Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy
Andrea Bialocerkowski1, Kirsty Kurlowicz, Sharon Vladusic
1School of Physiotherapy, The University of Melbourne, and Department of Plastic and Maxillofacial Surgery and Physiotherapy Department, Royal Children's Hospital, Melbourne, Victoria, and Centre for Allied Health Evidence (a collaborating centre of The Joanna Briggs Institute), University of South Australia, Adelaide, South Australia, Australia.
Insights
Evidence on primary conservative management for obstetric brachial plexus palsy is limited. More research is needed to establish effective treatments for this birth complication.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Obstetrics
Background:
- Obstetric brachial plexus palsy affects 1-3 per 1000 live births globally.
- Injury results from brachial plexus traction/compression during childbirth.
- Management options include conservative care and surgery, with ongoing debate on optimal approaches.
Purpose of the Study:
- To systematically review and synthesize evidence on the effectiveness of primary conservative management for obstetric brachial plexus palsy.
- To identify gaps in the current literature regarding treatment efficacy.
Main Methods:
- Systematic literature search across 14 databases (July 1992-June 2003).
- Inclusion of quantitative studies on primary conservative management.
- Exclusion of studies focusing solely on primary surgery or secondary deformities.
Main Results:
- Eight studies were included, mostly of low evidence hierarchy and fair methodological quality.
- No randomized controlled trials were identified.
- Conservative management protocols were inconsistently described, hindering replication.
- Outcome measures lacked documented validity, reliability, or sensitivity to change.
- Less severe cases were predominantly selected for conservative management, complicating generalizability.
Conclusions:
- There is scant and inconclusive evidence supporting the effectiveness of primary conservative intervention for obstetric brachial plexus palsy.
- Further research requires the development of validated outcome instruments for infants with this condition.
- Well-designed comparative studies utilizing robust outcome measures are essential for future research.
Abstract:
Background Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1-3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Results Eight studies were included in the review. Most were ranked low on the Hierarchy of Evidence (no randomised controlled trials were found), and had only fair methodological quality. Conservative management was variable and could consist of active or passive exercise, splints or traction. All studies lacked a clear description of what constituted conservative management, which would not allow the treatment to be replicated in the clinical setting. A variety of outcome instruments were used, none of which had evidence of validity, reliability or sensitivity to detect change. Furthermore, less severely affected infants were selected to receive conservative management. Therefore, it is difficult to draw conclusions regarding the effectiveness of conservative management for infants with obstetric brachial plexus palsy. Conclusions There is scant, inconclusive evidence regarding the effectiveness of primary conservative intervention for infants with obstetric brachial plexus palsy. Further research should be directed to develop outcome instruments with sound psychometric properties for infants with obstetric brachial plexus palsy and their families. These outcome instruments should then be used in well-designed comparative studies.
