Birth palsy: natural recovery course and combined root avulsion

Seventy-six patients with birth palsy were reviewed for type of palsy and mode of delivery. High incidences of root avulsion associated with lesser birth weight were identified in patients of breech deliveries. In 15 patients with serial neurological assessment for more than 5 years, the natural recovery course was evaluated, based on the assessment of particular key muscle and dermatomes mainly innervated by single nerve roots. Rapid and useful motor recovery was observed in upper-type palsy and the upper root levels (C5 and C6) of whole-type palsy, while poor prognosis of motor function was demonstrated in the lower root levels (C8 and D1) of whole-type palsy. Recovery of sensory function was far more predominant than recovery of motor function. Of 12 patients with root avulsion, 10 patients (27 avulsed roots) over 5 years of age were neurologically assessed. Of avulsed roots, 70.4% had useful sensory recovery and 33.3% had useful motor recovery. The patho-mechanism of those with a good prognosis in root avulsion of birth palsy is discussed, based on the findings of this series.