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Kelly L. VanderHave, Karen Bovid, Hilary Alpert, Kate Wan-Chu Chang, Douglas J. Quint, James A. Leonard Jr. and Lynda J. S. Yang

. Methods Following approval from our institutional review board, we conducted a retrospective review of patients referred to the Neonatal Brachial Plexus Program between 2007 and 2010. The total number of patients presenting when younger than 9 months of age (within operative decision-making age) was 120. Inclusion criteria included children who underwent brachial plexus exploration following preoperative EDSs and CTM. All patients underwent EDSs at 1 month of age in an attempt to identify the severe lesions. 14 Patients for whom early surgery was recommended

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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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Jacob Rahul Joseph, Michael A. DiPietro, Deepak Somashekar, Hemant A. Parmar and Lynda J. S. Yang

N eonatal brachial plexus palsy (NBPP) affects approximately 1.5 of every 1000 live births, 2 similar in incidence to cerebral palsy. A subset of NBPP patients will not recover spontaneously and will require surgical intervention to regain adequate arm function. Currently, operative exploration can confirm the extent (number of involved nerve roots) and severity of nerve injury within the brachial plexus, which is partially delineated by using preoperative modalities such as CT myelography, MRI, and electrodiagnostic studies. 1 , 6 , 10 , 12 , 14 , 17

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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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Mark A. Mahan, Wilson Z. Ray, Lynda J. S. Yang and Robert J. Spinner

technique is described by Henning et al. Decreasing surgery-related morbidity is particularly viable, especially with the posterior approach to the brachial plexus, as discussed by Crutcher et al. Nor should we consider the failure of one surgery as a failure of surgery, as we learn from van Gent and colleagues, when revision remains a viable option. Improvement in diagnosis comes from astute observation, such as the case of minimally visible pathology reported by Laumonerie et al., or that of minimally injurious biopsy, as discussed by Wilson and colleagues

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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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Jawad M. Khalifeh, Christopher F. Dibble, Anna Van Voorhis, Michelle Doering, Martin I. Boyer, Mark A. Mahan, Thomas J. Wilson, Rajiv Midha, Lynda J. S. Yang and Wilson Z. Ray

investigation of alternative strategies has remained a priority. Only recently have nerve transfers been considered a viable treatment option, used alone or in combination with tendon transfers. 14 , 22 Using the same principles successfully applied for high peripheral nerve and brachial plexus injuries, nerve transfers in SCI place regenerating axons that remain under volitional cortical control close to the target motor endplates. 37 Nerve transfers rely on redundant motor axons above the SCI to reinnervate targets below the SCI, while preserving the natural biomechanics