Impact of Timing of Primary Nerve Surgery on Shoulder, Forearm, and Elbow Recovery in Neonatal Brachial Plexus Palsy

Whitney E Muhlestein; Kate W-C Chang; Denise Justice; Virginia S Nelson; Yamaan S Saadeh; Brandon W Smith

doi:10.1227/neu.0000000000002803

Impact of Timing of Primary Nerve Surgery on Shoulder, Forearm, and Elbow Recovery in Neonatal Brachial Plexus Palsy

Neurosurgery. 2023 Dec 18. doi: 10.1227/neu.0000000000002803. Online ahead of print.

Authors

Whitney E Muhlestein¹, Kate W-C Chang¹, Denise Justice¹, Virginia S Nelson², Yamaan S Saadeh¹, Brandon W Smith³

Affiliations

¹ Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
² Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.
³ Department of Neurologic Surgery, Duke University, Durham, North Carolina, USA.

PMID: 38108400
DOI: 10.1227/neu.0000000000002803

Abstract

Background and objectives: Neonatal brachial plexus palsy (NBPP) almost universally affects movement at the shoulder, elbow, and forearm. Timing of nerve reconstruction surgery to optimize long-term outcomes remains unknown. This study aimed to determine if timing of nerve reconstruction affects long-term recovery of an active range of motion (AROM) at the shoulder, elbow, and forearm in NBPP.

Methods: We interrogated a prospectively collected database of all patients with NBPP who underwent primary nerve surgery at a single tertiary referral center between 2005 and 2020. The cohort was divided into those who underwent surgery at ≤6 or >6 months old and ≤9 or >9 months old. AROM for shoulder abduction, forward flexion, and external rotation, elbow flexion and extension, and forearm supination were collected at each visit.

Results: Ninety-nine children were included in the analysis; 28 underwent surgery at ≤6 months old, 71 at >6 months, 74 at ≤9 months, and 25 at >9 months. There was no difference in AROM at 5 years for any of the movements between the ≤6- and >6-month groups. The ≤9-month group had significantly better shoulder forward flexion and elbow extension AROM than the >9-month group at a 5-year follow-up and better forearm supination at up to a 15-year follow-up. Patients who presented earlier were more likely to have earlier operations.

Conclusion: Surgery before 9 months may improve long-term upper extremity recovery in NBPP. Early referral should be encouraged to optimize timing of operative intervention.