Prognosis

In general, the outlook for most patients with brachial plexus birth injury (BPBI) is good.[162] Many series have reported full recovery in more than 70% to 80% of children with BPBI, with absent to minimal long-term sequelae.[49][108][163]​​ The extent of nerve injury affects the degree of spontaneous recovery, and declines with increasing Narakas group as follows:​[14][96]

  • Group 1: rate of spontaneous recovery >80%

  • Group 2: rate of spontaneous recovery around 60%

  • Group 3: rate of spontaneous recovery <50%

  • Group 4: rate spontaneous recovery around 0%.

Children without full recovery by the age of 3 months are likely to have some residual impairment.[6][64][91]​[110]​​​ Long term deficits most commonly include restriction of shoulder movement, flexion contracture of the elbow, and reduction in forearm rotation. It is rare for active elbow flexion to not recover well.[91][96]​​ Hand function in children with severe global palsies improves after surgery in 48% to 93%, depending on definition.[96]​ In many children, the affected limb becomes nondominant, but activities that require bimanual function can be impacted.[96][164]​​ Some adults with BPBI go on to glenohumeral joint arthroplasty or arthrodesis.[165][166]​​ The long-term ability to perform activities of daily living and general function is good for most patients despite these limitations.[110][167][168][169]

​Children who do not experience full recovery will often have impairments of function requiring modification of activities, ongoing therapy, or surgical intervention; this may impact quality of life.[170] Some studies have found reduced mental health in children with BPBI but self-concept and social functioning were good in one study.[164][171]​ Additionally, ongoing medical malpractice litigation has been associated with worse parent reported function and pain.[172]

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