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Updated: Mar 12, 2026
Methods for In Vivo Biomechanical Testing on Brachial Plexus in Neonatal Piglets
Published on: December 19, 2019
Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy
Andrea Bialocerkowski1, Kirsty Kurlowicz, Sharon Vladusic
11School of Physiotherapy, The University of Melbourne, and 2Department of Plastic and Maxillofacial Surgery and 3Physiotherapy Department, Royal Children's Hospital, Melbourne, Victoria, and 4Centre 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 and inconclusive. Further research is needed to develop reliable outcome measures and conduct well-designed comparative studies for this common birth complication.
Area of Science:
- Pediatrics
- Neurology
- Physical Therapy
Background:
- Obstetric brachial plexus palsy (OBPP) affects 1-3 per 1000 live births globally.
- Injury results from brachial plexus traction/compression during childbirth, causing varied upper limb dysfunction.
- Current management, including conservative and surgical options, lacks consensus on optimal approach.
Purpose of the Study:
- To systematically review and synthesize evidence on the effectiveness of primary conservative management for OBPP in infants.
- To identify the best available evidence regarding non-surgical interventions for OBPP.
Main Methods:
- Systematic literature search across 14 databases (July 1992-June 2003).
- Inclusion of quantitative studies on primary conservative management; exclusion of studies on primary surgery or pharmacological agents.
- Two independent reviewers assessed study eligibility, design, and quality; narrative synthesis used due to heterogeneity.
Main Results:
- Eight studies were included, mostly of low evidence hierarchy and fair methodological quality.
- Conservative management approaches (exercise, splints, traction) were inconsistently described, hindering replication.
- Outcome measures lacked validated reliability and sensitivity; less severe cases were preferentially included, complicating conclusions.
Conclusions:
- Scant and inconclusive evidence exists regarding the effectiveness of primary conservative intervention for OBPP.
- Development of outcome instruments with sound psychometric properties is crucial for future research.
- Well-designed comparative studies utilizing validated outcome measures are recommended.
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.
