Neurosurgical management of birth injuries of the brachial plexus.

While most newborns with birth injury of the brachial plexus make a full spontaneous recovery, the minority who do not can expect lifelong disability from weakness, disturbed patterns of muscle activity, contracture, and deformity. Those children who are destined to a poor recovery can be identified in early infancy. Early reconstruction of the brachial plexus carries low morbidity and has been shown by many to support useful shoulder and elbow function. Patients who are referred later in childhood may still benefit from plexus exploration, but how to best use clinical and electrophysiologic data to plan a surgical intervention that will improve on the natural history remains to be elucidated for this group.