Hand function outcomes following surgical treatment of complete neonatal brachial plexus palsy
Mario Gilberto Siqueira1, Carlos Otto Heise2,3, Roberto Sergio Martins2
1Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, Rua Dr. Enéas Carvalho de Aguiar 255, 05403-000, São Paulo, SP, Brazil. mgsiqueira@uol.com.br.
Insights
Primary nerve reconstruction in infants with complete neonatal brachial plexus palsy (NBPP) can lead to functional hand recovery. Over half of infants achieved sufficient hand function for bimanual activities after surgery.
Area of Science:
- Pediatric Surgery
- Neurology
- Rehabilitation Medicine
Background:
- Complete neonatal brachial plexus palsy (NBPP) significantly impacts infant hand function.
- Re-innervation of the hand is a critical treatment goal for infants with NBPP.
- Limited research exists on hand function outcomes after primary nerve reconstruction in infants with NBPP.
Purpose of the Study:
- To evaluate hand function outcomes in infants with complete NBPP following primary nerve reconstruction.
- To determine the efficacy of surgical intervention for hand function recovery in this population.
Main Methods:
- Retrospective case series of patients undergoing primary nerve surgery for complete NBPP over 8 years.
- Hand function assessed using the Raimondi Hand Scale.
- Grade 3 or higher on the Raimondi scale indicates a functional hand for bimanual activity.
Main Results:
- Nineteen infants with complete NBPP underwent primary nerve reconstruction at a mean age of 3.7 months.
- Hand function was evaluated until at least 4 years of age.
- Overall hand functional recovery (Raimondi grade 3 or higher) was achieved in 57.8% (11/19) of patients.
Conclusions:
- Primary nerve reconstruction is a viable surgical option for improving hand function in infants with complete NBPP.
- Achieving sufficient hand function for bimanual activity is possible and should be prioritized in surgical management.
- These findings support early surgical intervention for optimal hand function outcomes.
Purpose:
Although re-innervation of the hand is considered a priority in the treatment of infants with complete brachial plexus injury, there is currently a paucity of publications investigating hand function outcomes following primary nerve reconstruction in infants with neonatal brachial plexus palsy (NBPP). This study therefore aimed to evaluate hand function outcomes in a series of patients with complete NBPP.
Methods:
This retrospective case series included all patients who underwent primary nerve surgery for complete neonatal brachial plexus palsy over an 8-year period. Outcomes were assessed using the Raimond Hand Scale. Classification of grade 3 or higher indicates a functional hand (assistance in bimanual activity).
Results:
Nineteen patients with a complete NBPP underwent primary nerve reconstruction at a mean age of 3.7 months. Periodic clinical evaluations were performed until at least 4 years of age. According to the Raimondi hand scale, one patient did not recover (grade 0), three patients attained grade 1, four grade 2, ten grade 3, and in one grade 4. Overall hand functional recovery was achieved in 57.8% (11/19) of patients.
Conclusion:
Sufficient recovery of hand function to perform bimanual activity tasks in patients with complete NBPP lesions is possible and should be a priority in the surgical treatment of these infants.
