Waters reviews obstetric brachial plexus palsy (0.1–0.4% of live births), covering natural history, prognostic factors, and the full spectrum of management from physical therapy to microsurgical reconstruction to secondary tendon transfers and osteotomies. The central question: when does observation end and surgery begin?
When evaluating a newborn with arm weakness, track biceps return serially: no recovery by 3 months demands formal scoring with the Toronto system, and a score below 3.5 should prompt microsurgical referral.
Horner's syndrome, total plexus involvement, or C5–C7 loss should lower your threshold for early referral regardless of absolute timing.
Waters reviews obstetric brachial plexus palsy (0.1–0.4% of live births), covering natural history, prognostic factors, and the full spectrum of management from physical therapy to microsurgical reconstruction to secondary tendon transfers and osteotomies. The central question: when does observation end and surgery begin?
When evaluating a newborn with arm weakness, track biceps return serially: no recovery by 3 months demands formal scoring with the Toronto system, and a score below 3.5 should prompt microsurgical referral.
Horner's syndrome, total plexus involvement, or C5–C7 loss should lower your threshold for early referral regardless of absolute timing.