The published experience of obstetrical brachial plexus palsy (OBPP) cases with poor
recovery and late neurosurgical intervention are sparse. This study included 19 cases
who presented after the age of 1 year with poor recovery of elbow and/or hand function
and electrophysiological evidence of reinnervation. Age at surgery averaged 41 months,
and the follow-up averaged 50 months. Distal neurotization was performed for
restoration of elbow flexion in 11 cases, elbow extension in 3 cases, and finger flexion
and/or sensibility in 5 cases. Active elbow flexion increased from an average of 2.7 to
91.8 degrees with an average gain of 89 degrees. Active elbow extension increased from
an average of 10 to 56.7 degrees with an average gain of 46.7 degrees. Although, three
out of five cases (60%) showed satisfactory recovery of finger flexion, all cases scored
< 2 using Raimondi score. Four cases gained protective sensation and one case gained
discriminative sensation. The results of neurotization in late OBPP are variable. The best
and most consistent results are obtained by necrotizing the biceps by the intercostal
nerves or, in selected cases, by the flexor carpi ulnaris fascicle of the ulnar nerve. Delayed
neurotization is the only way to recover sensory function in the hand.