Obstetric brachial plexus palsy: a comprehensive review of evaluation and management

Abstract

Obstetric brachial plexus palsy (OBPP) is the most common peripheral nerve injury associated with childbirth, with an incidence of 0.4–1.6 per 1000 live births. It typically results from traction on the brachial plexus during difficult deliveries and is associated with risk factors such as shoulder dystocia, fetal macrosomia, breech presentation, prolonged labour, and maternal diabetes. The severity of neurological involvement ranges from isolated upper trunk lesions (Erb’s palsy) to complete brachial plexus paralysis with associated Horner syndrome. Early and accurate clinical evaluation is critical for prognostication and treatment planning. Serial clinical examinations remain the cornerstone of assessment, while imaging and electrophysiological studies may aid in defining the level and severity of injury. Although spontaneous recovery occurs in a majority of infants, a significant subset requires timely surgical intervention. Advances in microsurgical techniques, including nerve grafting and distal nerve transfers, have improved functional outcomes. In addition to neural deficits, OBPP is associated with secondary musculoskeletal sequelae such as shoulder contractures and glenohumeral dysplasia. This review provides a comprehensive overview of the pathoanatomy, clinical evaluation, prognostic indicators, and contemporary management strategies for OBPP, with emphasis on surgical reconstruction and management of secondary deformities.