Current Environment:

Research focus: Brachial Plexus Program

The brachial plexus is a network of nerves that run from the cervical spine to the muscles of the upper limb. Brachial plexus birth injury refers to an injury to these nerves during childbirth.

The natural history of brachial plexus birth injury remains unknown, in part due to a lack of information on patients evaluated from birth to adulthood. Based on what’s currently known about brachial plexus birth injury, it’s generally accepted that microsurgery benefits infants:

  • without recovery of biceps function by the age of 6 months, and
  • with severe avulsion (a tear of the nerve at the spinal cord) injuries by 3 to 6 months of age

However, there’s significant controversy regarding the ideal timing for microsurgery whose long-term outcomes are unknown. The Brachial Plexus Program’s long-term TOBI (Treatment and Outcomes of Brachial Plexus Injury) study of brachial plexus birth injury treatment is an international effort that includes centers from North America, Europe, and Australia.

Within Boston Children’s Orthopedic Center, the Brachial Plexus Program, and the Clinical Effectiveness Research Center (CERC) are doing extensive research on brachial plexus birth injury, including grant-funded research through the American Society for Surgery of the Hand (ASSH) and the Pediatric Orthopaedic Society of North America (POSNA). This includes coordinating and analyzing data on brachial plexus patients from centers throughout North America in the TOBI (Treatment and Outcomes Brachial Plexus Injuries) study.

The primary goal of this multi-center study is to determine the optimal age for microsurgical repair in infants with brachial plexus birth palsy and persistent upper extremity weakness. We’ll also compare the results of early microsurgery to those of secondary reconstructive surgery.

This research is an effort to establish a standard of care at all hospitals, and to determine the natural history (spontaneous recovery) and microsurgery results for brachial plexus injuries. Our program is coordinating this multi-center TOBI study over the next five years to determine the timing of microsurgery, tendon transfers and osteotomies.

We present all of our research papers on a national basis and publish these results in peer-review journals. Numerous papers have already been published and presented in these areas and will continue to be published prospectively.

Please note: All patients with brachial plexus birth injury are invited to participate in this clinical study. During your visit with us, you will be approached by a research coordinator to participate in this and other studies - to help your child, you, and other children and parents determine what is best for infants and children with brachial plexus injuries.

Brachial plexus team publications