Bilateral brachial plexus injury – A scoping review

Bilateral brachial plexus injury (BBPI) is an exceptionally rare but profoundly disabling condition due to the absence of a compensatory upper limb. The available evidence is limited to isolated case reports and very small series, restricting the development of standardized diagnostic and management strategies. This scoping review was conducted to map the existing literature on BBPI, with a focus on etiologies, diagnostic approaches, management strategies, and outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, a comprehensive search of PubMed, Embase, Scopus, and Web of Science (from inception to September 2025) identified 13 publications encompassing 13 patients. Etiologies were broadly categorized into traumatic (7/13), non-traumatic (5/13), and obstetric (1/13) causes; the non-traumatic group included positional/iatrogenic, compressive, and toxic/immobilization mechanisms. Injuries were frequently asymmetric, with one limb demonstrating more severe structural damage. Management varied depending on etiology and severity; traumatic injuries more often underwent surgical reconstruction (neurolysis, nerve grafting, or nerve transfers), often with the goal of restoring elbow flexion, whereas non-traumatic injuries were generally managed conservatively with rehabilitation. Outcomes were heterogeneous: four patients achieved full-to-near-full recovery, five attained partial but functionally useful recovery, and four had poor outcomes. Overall, 9 of 13 patients regained at least one functionally useful limb; however, these descriptive proportions should be interpreted with caution, given the very small sample size. Based on limited case-level evidence, BBPI encompasses diverse mechanisms requiring individualized management strategies. Early recognition, careful differentiation from central causes, timely intervention in selected cases, and intensive multidisciplinary rehabilitation appear critical. Given the rarity and heterogeneity of BBPI, coordinated reporting and multicenter registries are necessary to refine prognostication and guide future reconstructive strategies.