Management of the BP consists of an aggressive diagnostic and surgical approach in the form of an emergency exploration and exploration of the brachial plexus by a multidisciplinary team of experts. It is vital to have a clear understanding of the anatomical structures involved in the injury and their appropriate management, if possible. In most cases an early approach will yield the best results. Although most BP injuries are seen in older children, the pattern of injury seen in neonates is similar, except that the ulnar nerve is more often affected. Isolated ulnar nerve injuries are often secondary to injury of the brachial plexus. The ulnar nerve may be injured within the plexus, or as it courses away from the plexus. Injuries to the ulnar nerve are more often secondary to injury of the radial nerve. Pregnancy does not appear to be a risk factor for BP injuries. However, some studies have suggested that pelvic fractures in pregnant patients increase the risk of brachial plexus injury. This has been suggested as a result of increased pressure within the pelvic cavity, which can lead to stretching of the axillary and supraclavicular nerves and subsequent damage to the brachial plexus. The diagnosis of BP injuries in the very young remains problematic. Clinical examination of neonates may be difficult due to lack of cooperation and therefore delayed diagnosis may occur.
The overall prognosis of BP injuries is favorable with an excellent functional recovery in a majority of patients. An understanding of the mechanisms responsible for injury, together with optimal medical and surgical management, will help to prevent deformities and sequelae in the arm, shoulder, and neck. These include complex regional pain syndrome, deformation of the shoulder, nerve palsies, and subsequent complications such as numbness, weakness, and atrophy of the muscles and joints. Injuries of the axillary nerve are associated with a higher incidence of shoulder deformities. The prognosis for those with acute isolated injuries is good. Symptoms usually resolve in 3 to 6 months. Damage to the supraclavicular nerve is more problematic because it may cause severe shoulder deformities. The prognosis for these injuries is poor. However, nerves between the brachial plexus and the cervical spine can be avulsed, and the lesion may become chronic, leading to permanent nerve damage and dysfunction. Avulsion of the cervical nerve roots is rare but can lead to dysfunction of the shoulder, elbow, and wrist.