The Montefiore Einstein Approach to Brachial Plexus Birth Injury

Introduction Brachial plexus birth injury (BPBI) is a heterogeneous condition with variable recovery and potential for lifelong functional impairment. Problem Despite advances in care, substantial variability persists in evaluation, timing of intervention, and reconstructive strategy across institutions. Increasing evidence supports surveillance-based, multidisciplinary models that emphasize recovery trajectory, early identification of secondary deformity, and integration of surgical and rehabilitative care. Solution We describe the Montefiore Einstein approach to BPBI, a prospective, surveillance-driven, multidisciplinary care model spanning infancy through adolescence. This framework integrates serial clinical assessment, selective adjunctive diagnostics, structured nonoperative management, biologically informed microsurgical reconstruction, and surgeon-coordinated rehabilitation. Key components include early enrollment into a longitudinal surveillance pathway, standardized use of the Active Movement Scale, routine ultrasound screening for glenohumeral dysplasia, trajectory-based surgical decision-making, and combined proximal and distal nerve reconstruction strategies. Conclusion BPBI should be conceptualized as a longitudinal condition requiring surveillance-driven, multidisciplinary care. The Montefiore Einstein approach provides a reproducible framework that integrates serial clinical evaluation, biologically informed reconstruction, and coordinated rehabilitation to optimize functional outcomes across the lifespan.