ABSTRACT
Paralysis of the shoulder and elbow following obstetric brachial plexus injury occurs with upper arm and wholearm types of lesions. Fortunately, the majority of obstetric brachial plexus injuries are neurapraxia and, consequently, these palsies are transient with complete recovery of function. A pre-ganglionic avulsion of the roots of the plexus may be suspected if the infant has an associated Horner syndrome or phrenic nerve avulsion with paralysis of the hemidiaphragm. All infants with obstetric brachial plexus injuries should be kept under close observation for the first three months after birth to document the extent and timing of recovery of motor power. Passive range-of-motion exercises need to be performed every day on a very regular basis to prevent contractures from developing in all children with obstetric brachial plexus injuries. In particular, passive external rotation exercises must be performed religiously to prevent an internal rotation contracture which is the prime reason for posterior subluxation and dislocation of the shoulder.
