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Kate W. C. Chang, Denise Justice, Kevin C. Chung, and Lynda J. S. Yang

N eonatal brachial plexus palsy is a devastating disablement occurring in the perinatal period that results in paralysis and/or paresis and loss of sensation in the affected limb in approximately 0.4–2.6 per 1000 live births in the US. 18 , 20 , 35 , 42 Among the affected infants, at least 69% recover spontaneously within several months. 20 , 42 , 58 However, for patients who do not recover spontaneously, nerve reconstruction and/or secondary musculoskeletal surgery can improve outcomes. 23 , 47 , 51 , 60 Regardless of optimal medical or surgical

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Joseph Domino, Connie McGovern, Kate W. C. Chang, Noelle E. Carlozzi, and Lynda J. S. Yang

P erinatal disorders are prone to malpractice litigation because of the emotionally charged environment in the perinatal period. Neonatal brachial plexus palsy (NBPP) is a perinatal condition that manifests as a paretic or paralytic arm that results from stretching the nerves of the brachial plexus. The disorder has a reported incidence (rivaling cerebral palsy) of 1–4 cases in 1000 live births and is a major physical perinatal disorder encountered by practitioners. 8 The etiology of NBPP includes intrauterine forces, maternal propulsive forces, and

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Thomas J. Wilson, Kate W. C. Chang, Suneet P. Chauhan, and Lynda J. S. Yang

N eonatal brachial plexus palsy (NBPP) results from the stretching of the nerves of the brachial plexus before, during, or after delivery. This disorder occurs in approximately 0.42 to 2.9 per 1000 live births. 3 , 11 , 14 , 16 The resulting neurological deficit depends on the portion of the brachial plexus that was injured, with the most common pattern being injury to C-5 and C-6 nerve roots (and/or upper trunk), resulting in weakness of shoulder abduction, external rotation, and elbow flexion. 7 Previous studies in the literature suggest that some

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Kate W. C. Chang, Thomas J. Wilson, Miriana Popadich, Susan H. Brown, Kevin C. Chung, and Lynda J. S. Yang

E ach year, neonatal brachial plexus palsy (NBPP) affects approximately 1.5 per 1000 live births in the United States. 43 , 45 Stretching of the nerves comprising the brachial plexus during the perinatal period results in weakness or paralysis of the shoulder, elbow, wrist, and/or hand. Approximately 10%–40% of infants with NBPP will have persistent NBPP at 1 year of age. 11 , 43 , 56 Depending on the site and severity of the injury, timely diagnosis, early referral, and surgical intervention can potentially benefit infants with persistent NBPP to maximize

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Brandon W. Smith, Nicholas J. Chulski, Ann A. Little, Kate W. C. Chang, and Lynda J. S. Yang

N eonatal brachial plexus palsy (NBPP) affects 1–4 of 1000 live births in the United States each year, and approximately 10%–40% of these children are left with residual weakness. 35 Given that a majority of these injuries involve the upper trunk, elbow weakness is a common deficit in these children. The Oberlin, or ulnar to musculocutaneous, nerve transfer is a common method used to restore elbow flexion in patients with deficits in this movement: The indications for the use of this procedure over graft repair remain controversial, and guidelines for use have

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Brandon W. Smith, Kate W. C. Chang, Lynda J. S. Yang, and Mary Catherine Spires

T he evaluation and treatment of neonatal brachial plexus palsy (NBPP) have continued to evolve and improve over the past 30 years. However, many controversial topics remain in this field. Across the major brachial plexus clinical programs, a wide variation persists in algorithms and decision making, specifically regarding the timing of surgery, indications, procedure selection, and the incorporation of ancillary testing. Preoperative ancillary testing may include electrodiagnostic testing (EDX) and various imaging modalities. The main goals of preoperative

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Brandon W. Smith, Kate W. C. Chang, Sravanthi Koduri, and Lynda J. S. Yang

N eonatal brachial plexus palsy (NBPP) occurs in approximately 1.5 of 1000 live births. 1 The primary mechanism of injury involves downward traction on the shoulder, leading to damage to the upper plexus during the perinatal period. 2 The most commonly used classification scheme comprises four groups based on the extent (or number) of nerve roots involved and the presence of Horner’s syndrome, rather than the severity of injury at each of the nerve roots. The natural history of these injuries indicates that 20%–30% of infants will have persistent disabilities

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Brandon W. Smith, Kate W. C. Chang, Hemant A. Parmar, Mohannad Ibrahim, and Lynda J. S. Yang

N eonatal brachial plexus palsy (NBPP) occurs in 1–4/1000 births in the United States. 1 Most of these patients recover; however, 30%–40% continue to have severe deficits and may be amenable to surgical nerve reconstructions. 2 Traditionally, brachial plexus injuries have been classified into two categories by location of the lesion: nerve root avulsions (preganglionic injuries) and nerve ruptures (postganglionic injuries). 3–5 Nerve root avulsions represent the most severe injury, with a complete disconnection from the central nervous