Waters' 2005 narrative review synthesizes the literature on pediatric brachial plexus birth palsy, addressing three contested areas: how to interpret natural history to determine who needs surgery, when to perform microsurgical reconstruction (especially for extraforaminal ruptures), and how to select and time secondary shoulder reconstruction based on glenohumeral deformity grade.
When a brachial plexus birth palsy infant still lacks antigravity biceps at 5–6 months, microsurgical reconstruction is indicated — but if they recover between 3–6 months, secondary shoulder reconstruction (latissimus dorsi/teres major transfer) can bring them to a comparable Mallet grade IV outcome.
Use the Waters glenohumeral deformity grade on MRI to decide between soft tissue procedures (grades I–II) and humeral osteotomy (grades IV–V) before committing to a surgical plan.
Waters' 2005 narrative review synthesizes the literature on pediatric brachial plexus birth palsy, addressing three contested areas: how to interpret natural history to determine who needs surgery, when to perform microsurgical reconstruction (especially for extraforaminal ruptures), and how to select and time secondary shoulder reconstruction based on glenohumeral deformity grade.
When a brachial plexus birth palsy infant still lacks antigravity biceps at 5–6 months, microsurgical reconstruction is indicated — but if they recover between 3–6 months, secondary shoulder reconstruction (latissimus dorsi/teres major transfer) can bring them to a comparable Mallet grade IV outcome.
Use the Waters glenohumeral deformity grade on MRI to decide between soft tissue procedures (grades I–II) and humeral osteotomy (grades IV–V) before committing to a surgical plan.