INTERNATIONAL OUTREACH DAYS (DUBAI, UAE 2010)
• April 26 2010 - Morning - families
• April 26 2010 - Afternoon - adults
• United States Outreach Days
• Please email the Outreach Coordinator at tnpiclinics@gmail.com

Children

The term "obstetrical palsy" was first used by Duchenne in 1872, and the description of upper root injury was described by Erb in 1874. The first surgical management of obstetric brachial plexus injury (OBPI) was reported in the early 1900's although results were poor and mortality was high. The majority of children with obstetric brachial plexus injuries have risk factors for a difficult delivery such as large size, use of forceps or vacuum, and shoulder dystocia. The successful surgical treatment of brachial plexus injuries awaited the development of microsurgical techniques in the 1970's. The modern surgical management of obstetric brachial plexus injury is generally based on the studies of A. Gilbert and J. Tassin in the early 1980's in France. Tassin followed 44 children with OBPI for a period of 5 years without surgery in order to determine the natural history of the injury. Based on this study, Gilbert and Tassin proposed several indications for surgery:

• When the biceps and deltoid recover by 1 to 2 months, a full recovery is likely
  and no surgery is indicated.
  
• When the biceps and deltoid recover by 3 to 4 months, a reasonable outcome
  is likely and no surgery is indicated.
  
• Poor outcomes result if recovery begins after 3 to 4 months, and surgery is indicated.

We basically follow these principles at The Nath Brachial Plexus Institute, although we do tend to wait until 4 or 5 months of age before recommending surgery. In our experience, this will allow maximum spontaneous recovery without losing time before muscle atrophy.

Gilbert and Tassin also studied the functional outcome of another group of children following surgery when compared to the untreated 44 described by Tassin. Their conclusion was that surgery, including nerve grafting and neurolysis (removal of scar), did result in significant improvement in function. Over 1200 children and adults have undergone primary surgery, with Dr. Nath, on the injured nerves, and virtually all have shown improvement with no loss of function. The results we have witnessed are even superior to that of Gilbert and Tassin.

The concept that surgery will improve function in OBPI has been supported in many other studies worldwide.

At The Nath Brachial Plexus Institute, we believe strongly that surgical intervention in appropriate cases will maximize movement and sensation in the affected arm and hand. We believe that the key to our success is in careful selection of appropriate patients and timely surgical intervention with the latest techniques in nerve reconstruction.