Obstetrical brachial plexus palsy (OBPP) outcome with conservative management

Resurgence of neurosurgical intervention of obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus palsies, and 63% were mild. Forty-two infants required no long-term follow-up because they rated 1 or 2 on initial physical examination. Comparing first and last follow-up clinical findings of the remaining 149 patients, there was high agreement (correlation r= 0.81; P < 0.001). Pearson correlation of initial physical exam with electrodiagnosis at three intervals was relatively stable (r= 0.87, 0.88, 0.69). One hundred eight (72%) of the patients remained in their original severity groups. Thirty-three of 41 patients with discrepant follow-up scores improved by at least one category. Eight patients deteriorated. The natural pathophysiology and recovery of OBPP is presented.