Review of obstetrical palsies. Nonoperative treatment.

For the majority of patients with obstetrical brachial plexus palsy, present-day conservative management yields good results. We now must direct our efforts toward improving the 10 to 15 per cent of patients who do not do well. Presently the role of microsurgical reconstruction of these injuries is undergoing evaluation. We must identify the patients with poor prognosis early: Babies should be examined at monthly intervals to document functional return, to supervise the child's exercise program, and to provide parental support. Babies who do not improve rapidly within the first 2 to 3 months should have an electromyogram and nerve conduction study. If this shows evidence of a severe lesion, these patients should be referred to a physician with a special interest in this area.