Restoration of Hand Function in Birth Brachial Plexus Injury

Birth brachial plexus palsy (BBPP) can lead to significant functional impairment of the upper limb, particularly affecting hand function. Despite advancements in primary nerve reconstruction, many patients require secondary procedures to optimise hand use. This study evaluates surgical strategies aimed at restoring hand function in BBPP, emphasising the timing of intervention, nerve transfer options and reconstructive techniques. A comprehensive review of direct root transfers, secondary tendon transfers, along with an analysis of sensory re-education and long-term functional outcomes. Early nerve reconstruction, particularly nerve transfers to the lower trunk or medial cord, demonstrated superior functional recovery when performed within the critical period of motor endplate viability. Secondary tendon and free muscle transfers proved beneficial in patients with persistent deficits, particularly for enhancing grasp, pinch and intrinsic hand function. Sensory recovery remained a key determinant of overall hand utility, with targeted nerve transfers improving protective sensation. Optimising hand function in BBPP requires a multimodal approach tailored to each patient's residual deficits. Early nerve surgery provides the best potential for meaningful recovery, while secondary procedures play a crucial role in refining outcomes. Understanding the interplay between motor and sensory recovery is essential for achieving the best functional restoration. Level of Evidence: Level V (Therapeutic).