Peripheral Nerve Decompression for Pain Relief in the Setting of Previous Obstetrical Brachial Plexus Injury: A Retrospective Case Series

Purpose In children with previous obstetrical brachial plexus injury (OBPI) upper extremity pain is present in 45 to 66% of patients. Recent literature reports this as musculoskeletal or neuropathic in nature. The purpose of the study is to demonstrate that peripheral nerve decompression and neurolysis may be an effective treatment for patients with upper extremity pain in the context of previous OBPI. Methods A retrospective chart review was performed on patients undergoing peripheral nerve decompression and neurolysis after OBPI by senior author. The primary outcome assessed was pain and secondary outcome measure was range of motion of the wrist and elbow. Outcome measures were assessed preoperatively as well as at their subsequent follow-up. Results Six patients were included, with a mean age of 14 years old at time of decompression. Three patients underwent median nerve, two patients underwent ulnar nerve and one patient underwent posterior interosseous nerve decompression. There was a substantial improvement in pain post-operatively, demonstrated by reduction or resolution of subjective pain in all patients and resolution of Tinel’s sign. There was a modest improvement in range of motion. Conclusion This study demonstrates an improvement in subjective pain and range of motion after decompression and neurolysis in OBPI patients with peripheral neuropathy. Appropriate identification of this pathology through routine follow-up with a multidisciplinary clinic allows for early recognition and symptom relief. Future research should focus on assessment and treatment of pain in this population on a larger scale.