Affiliations: Department of Hand and Reconstructive Microsurgery,
National University Hospital, Singapore | Section of Plastic Surgery, Department of Surgery, The
University of Michigan Health System, Ann Arbor, MI, USA
Note: [] Corresponding author: Sandeep J. Sebastin, MMed (Surgery), MCh
(Plastic), Associate Consultant, Hand & Reconstructive Microsurgery,
National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 11,
119228, Singapore. Tel.: +65 6772 5549; Fax: +65 6773 2558; E-mail:
sandeepsebastin@gmail.com
Abstract: The incidence of neonatal brachial plexus palsy (NBPP) has remained
relatively stable despite awareness of the problem and improved obstetric
techniques. Deformities of the forearm and hand can result either from
untreated NBPP or following early microsurgical nerve reconstruction. These
deformities include limb length discrepancy, flexion contracture of the elbow,
supination or pronation contractures of the forearm, ulnar deviation of the
wrist, and varying types of finger paralysis. The treatment options for these
deformities consist of soft tissue releases, corrective osteotomies, tendon
transfers, joint fusions, and/or free muscle transfers. Rehabilitation and
physical therapy treatment are critical after these procedures. This article
reviews the pathogenesis of the common deformities seen in a late presentation
of NBPP, the assessment of these children, and provides a reconstructive
strategy for the management of this difficult problem.
