Objective: To document the natural history of brachial plexus birth palsy in relation to the recovery of elbow flexion and shoulder flexion in the first six months of life; to assess the outcome after microsurgery of the brachial plexus in patients who had no recovery of bicep function at six months.
Study design: The present study employed retrospective clinical data analysis.
Material and Method: The patients were divided in two groups, nonoperated and operated. The non-operative patients were followed either to full recovery or until the maximum expected motor recovery. The type of surgical procedure and final muscle strength was recorded in the operative group. Every child was evaluated for motor function including bicep muscle and shoulder elevation and then was followed until the surgeon considered the appropriate time for surgery.
Results: Between 2001 and 2010, 88 children with birth palsy were seen with 89 brachial plexus birth palsies. Seven children were excluded due to incomplete data. The remaining 82 palsies in 81 babies were classified in two groups. In the nonoperated group, the spontaneous recovery occurred in 59 patients (73%) of 81 patients. All of these patients showed functional bicep within ten months of age. Bicep contraction was observed by six months of age in 63 patients (71%). In all, 22 infants in the operated group, underwent an exploration of the brachial plexus, neurolysis and neurotization, Functional recovery of the elbow occurred in 15 cases, The pre-operative AMS for elbow and shoulder flexion were 1.72 and 2.18, respectively. The postoperative mean AMS for elbow flexion was 5.30 and shoulder flexion was 5.55.
Conclusion: Most babies with traction injuries of the brachial plexus at birth have an excellent prognosis if the recovery has
started within three months. Microsurgical reconstruction was effective in improving function in the small subgroup of patients with no evidence of recovery of bicep function within the first six months of life.

Keywords: Birth palsy, Brachial plexus birth palsy, Neurotization