Related Experiment Video

Updated: Apr 12, 2026

Development of a Neonatal Rat Model for Brachial Plexus Birth Injury

Development of a Neonatal Rat Model for Brachial Plexus Birth Injury

Published on: March 27, 2026

Birth weight and incidence of surgical obstetric brachial plexus injury

Rahul K Nath¹, Meera B Avila¹, Sonya E Melcher¹

¹Texas Nerve and Paralysis Institute, Houston, TX.

|May 20, 2015

Insights

Many obstetric brachial plexus injury (OBPI) patients needing surgery have normal birth weights. Macrosomic and nonmacrosomic OBPI patients showed similar injury severity and surgical outcomes, with improved shoulder function post-surgery.

Area of Science:

Pediatric Surgery
Neurology
Orthopedics

Background:

Obstetric brachial plexus injury (OBPI) is a birth-related nerve injury impacting shoulder function.
Reconstructive surgery is often necessary for severe OBPI cases.
The role of birth weight, specifically macrosomia, in OBPI severity and surgical outcomes is not fully understood.

Purpose of the Study:

To analyze the birth weight distribution of OBPI patients undergoing reconstructive surgery.
To compare OBPI injury severity and surgical outcomes between macrosomic and nonmacrosomic infants.
To evaluate the effectiveness of the modified Quad surgery in relation to birth weight.

Main Methods:

An observational cohort study included 100 consecutive OBPI patients undergoing surgery.
Birth weight was analyzed, with macrosomia defined as >4000g or >4500g.
Surgical outcomes were assessed by evaluating video recordings of active shoulder abduction pre- and post-operatively.

Main Results:

52% of OBPI patients were macrosomic using a 4000g definition; 18% using a 4500g definition.
A significant proportion (48%-82%) of OBPI patients requiring surgery had normal birth weights.
No significant difference in injury severity or modified Quad surgery outcomes was found between macrosomic and nonmacrosomic groups.

Conclusions:

OBPI requiring reconstructive surgery is not exclusive to macrosomic infants; many have normal birth weights.
Macrosomia does not appear to influence OBPI injury severity or the effectiveness of the modified Quad surgery.
The modified Quad surgery significantly improves shoulder movement in both macrosomic and nonmacrosomic OBPI patients.

Read full analysis

Abstract

Objectives:

(1) To analyze the birth weight of obstetric brachial plexus injury (OBPI) patients requiring one or more reconstructive surgeries and (2) to analyze whether there is any difference in the severity of the injury, and the outcome of the surgery between the macrosomic and nonmacrosomic OBPI patients.

Study Design:

An observational cohort study was performed on 100 consecutive patients treated with surgery at the Texas Nerve and Paralysis Institute. Ninety of the 100 patients underwent the modified Quad surgery, which improves the shoulder abduction and overall shoulder function. All OBPI patients in our study were assessed preoperatively and postoperatively by evaluating video recordings of active shoulder abduction.

Results:

Using a 4000 g definition of macrosomia, 52% of patients would be considered macrosomic, and using a 4500 g definition of macrosomia, 18% of patients are considered macrosomic in our study. Permanent injury occurs also in average-birth-weight children.

Conclusions:

A significant percentage (48%-82% depending on definition of macrosomia) of OBPI patients requiring major reconstructive surgery had birth weights which would put them in the "normal" birth weight category. In addition, we found that there was no significant difference in the severity of the injury, and the outcome of the modified Quad surgical procedure between macrosomic and nonmacrosomic OBPI patients. However, there was a significant improvement in shoulder movement in both macrosomic and nonmacrosomic patients after modified Quad surgery.

Keywords:

Mod Quad surgery birth weight macrosomia obstetric brachial plexus injury (OBPI)shoulder dystocia

More Related Videos

Methods for In Vivo Biomechanical Testing on Brachial Plexus in Neonatal Piglets

Methods for In Vivo Biomechanical Testing on Brachial Plexus in Neonatal Piglets

Published on: December 19, 2019

Surface Electromyographic Biofeedback as a Rehabilitation Tool for Patients with Global Brachial Plexus Injury Receiving Bionic Reconstruction

Surface Electromyographic Biofeedback as a Rehabilitation Tool for Patients with Global Brachial Plexus Injury Receiving Bionic Reconstruction

Published on: September 28, 2019

Related Concept Videos

Spinal Nerves: Plexus I

Spinal Nerves: Plexus I

Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...

Peripheral Artery Disease V: Postoperative Nursing Management

Peripheral Artery Disease V: Postoperative Nursing Management

During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...

Sites for measuring blood pressure

Sites for measuring blood pressure

Blood pressure measurement is a fundamental clinical procedure, providing crucial data for assessing cardiovascular health. Among the various sites for this measurement, the brachial and popliteal arteries are predominantly utilized due to their accessibility and the reliability of their readings. This lesson delves into the anatomical significance, methodology, and considerations of measuring blood pressure at these locations.
The Brachial Artery: Primary Site for Blood Pressure Measurement

Articles linked to this work by shared authors, journal, and citation graph.

Coincidence of Brachial Plexus Upper Trunk and Long Thoracic Nerve Injuries in 50 Patients With Winged Scapula: Improvements in Shoulder Stability and Functional Movements After Decompression and Neurolysis.

Eplasty·2024

Foot drop secondary to rhabdomyolysis: improved foot dorsiflexion and gait after neurolysis and distal nerve transfer-a case series and literature review.

Journal of surgical case reports·2023

Incidence, Etiology, and Risk Factors Associated with Foot Drop.

Eplasty·2023

Double Fascicular Nerve Transfer Restored Nearly Normal Functional Movements in a Completely Paralyzed Upper Extremity Resulting from an ACDF Surgery: A Case Report and Review of Recent Literature.

The American journal of case reports·2023

Iatrogenic nerve injury and foot drop: Surgical results in 28 patients.

Surgical neurology international·2022

Comparing the Results of External Rotational Humeral Osteotomy in Older Children to the Mod Quad and Triangle Tilt Procedures in Adults with Obstetric Brachial Plexus Injury.

Eplasty·2022

See all related articles