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Round table discussion. The management of complete brachial plexus birth injury

Tim Hems1, Dan Zlotolow2, Kevin J Little3

  • 1Scottish National Brachial Plexus Injury Service, Queen Elizabeth University Hospital and Royal Hospital for Children, UK.

The Journal of Hand Surgery, European Volume
|November 22, 2025
PubMed

Insights

Complete brachial plexus birth injury severely limits upper limb function. Expert surgeons discuss non-operative and operative management, including C7 nerve root transfer, for improved outcomes.

Area of Science:

  • Pediatric Surgery
  • Neurology
  • Orthopedic Surgery

Background:

  • Complete brachial plexus birth injury causes significant upper limb functional deficits.
  • Management strategies for these injuries lack high-level evidence.
  • Surgical intervention, including microsurgical repair, is frequently considered.

Purpose of the Study:

  • To gather expert opinions on managing complete brachial plexus birth injuries.
  • To explore evidence for operative and non-operative treatment approaches.
  • To discuss specific surgical techniques like contralateral C7 nerve root transfer.

Main Methods:

  • Three expert brachial plexus surgeons were surveyed.
  • Questions focused on non-operative outcomes, surgical strategies, and nerve transfers.
  • Evidence for surgical reconstruction and functional improvement was reviewed.

Main Results:

  • Expert insights were provided on various management options.
  • Indications for contralateral C7 nerve root transfer were detailed.
  • Discussion included evidence supporting nerve surgery and hand function improvement.

Conclusions:

  • Management of complete brachial plexus birth injury remains challenging.
  • Expert consensus offers guidance in the absence of high-level evidence.
  • Surgical reconstruction, including C7 transfer, shows potential for functional recovery.

Keywords:
Brachial plexus birth injurybrachial plexus explorationcomplete paralysiscontralateral C7 transferhand functionmicrosurgical nerve repairnon-operative managementobstetric brachial plexus injuryoutcomes

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