Obstetric brachial plexus injuries: assessment protocol and functional outcome at age 5 years

One hundred and five children with the whole spectrum of obstetric brachial plexus (OBP) injuries, from severe to full recovery, were examined at the age of 5 years with regard to motor and sensory functions as well as to use of the affected limb. Since root involvement level does not fully reflect the degree of disability, a classification based on range of motion and grip-strength was formulated and found to correspond well with functional abilities. The results from this study indicate that the eventual outcome in upper-plexus lesions is more complex than is commonly believed. Hand function is affected due to the effect of limited shoulder movements on hand positioning. Grip strength was also reduced in many of these children. All the children with total-plexus lesions had diminished grip strength and half of them had impaired tactile sensibility. In most children with total-plexus lesions, performance of activities in daily life was affected as were bimanual activities requiring use of the involved limb. Hand preference was affected in children with a right-sided injury. From a clinical perspective, as well as for research, it is important to describe OBP injuries not only in terms of impairment but also of disability.