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Updated: Dec 29, 2025
Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
C5-8 neonatal brachial plexus palsy. Operative findings, reconstructive strategy and outcome
Aude Lombard1, Manon Bachy1, Frank Fitoussi1
1Department of Pediatric Orthopedic and Reconstructive Surgery Trousseau Hospital, Sorbonne Medical University, Paris, France.
Insights
Primary brachial plexus repair in children with C5-8 palsy restores elbow flexion and hand function. Secondary surgeries are often needed for shoulder and wrist deficits, requiring family counseling.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Rehabilitation Medicine
Background:
- Neonatal brachial plexus palsy (NBPP) affects nerve function in infants.
- C5-8 palsy involves significant upper extremity impairment.
- Primary surgical repair aims to restore nerve function early.
Purpose of the Study:
- To evaluate the outcomes of primary brachial plexus repair in children with C5-8 palsy.
- To assess functional recovery of the shoulder, elbow, and hand.
- To determine the necessity and impact of secondary surgical procedures.
Main Methods:
- Retrospective review of 24 children with C5-8 palsy undergoing primary brachial plexus repair (1998-2014).
- Surgical focus on upper trunk repair.
- Assessment of functional outcomes using Mallet, Raimondi, and active movement scales.
- Analysis of secondary procedures for persistent deficits.
Main Results:
- Median follow-up of 9.7 years.
- Good restoration of elbow flexion (median active movement scale 7 for biceps).
- Functional hand recovery (mean Raimondi score 3.3).
- Shoulder external rotation and wrist extension deficits required secondary surgery in 21 patients.
Conclusions:
- Primary C5-8 brachial plexus reconstruction effectively restores elbow flexion and provides a sensitive, functional hand.
- Secondary surgical interventions are frequently necessary to address residual shoulder and wrist dysfunction.
- Informed family counseling regarding potential secondary surgeries is crucial.
Abstract:
From 1998 to 2014, we performed primary brachial plexus repair in 260 children with neonatal brachial plexus palsy. Thirty-three presented with a C5-8 palsy and 24 were reviewed for this study. The surgical strategy was to focus on repairing the upper trunk. Secondary surgical procedures were performed in 21 patients, mainly for shoulder external rotation deficit or weak wrist extension. After a mean follow-up of 9.7 years (range 3 to 19), the median Mallet score for the shoulder was 9.5 and the mean Raimondi score for the hand was 3.3. Median active movement scale was 5, 7 and 5.5 for the deltoid, biceps and triceps, respectively. We conclude that primary C5-8 brachial plexus reconstruction provides restoration of elbow flexion and most patients have a sensitive and functional hand. We also found that secondary surgery to improve shoulder and wrist function is often necessary, which should initially be explained to the family.Level of evidence: IV.
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