Objectives: Restoration of shoulder external rotation is very important to upper extremity function following obstetrical brachial plexus paralysis. The purpose of this study is to present our experience with the secondary restoration of external rotation in patients with obstetrical brachial plexus palsy.

Methods: From 1978 to 2002, 46 children underwent secondary surgery for the restoration of their external rotation. Outcomes will be analyzed in relation to various factors including the type of procedure (muscle transfer only, MT, versus exploration and muscle transfer, N+MT), denervation time, type of injury (Erb's versus Global), and severity score.

Results: There was a significant improvement in every case (p<0.01) between preop and postop. The overall mean postoperative achieved Mallet score for the group of muscle transfer (MT) only was 3.6 (SD+0.681), while in the other (N+MT) was 3.67 (SD+0.482) (p>0.05). The resulting external rotation was 45° versus 41.7°. However, children with primary reconstruction achieved a significantly better outcome (68.7°). Patients with Erb's palsy had a significant better result compared to those with global palsy in both Mallet score (3.82 vs. 3.48) and final active external rotation (49.8° vs. 37°). Children who underwent early surgery, less than 6 months did not yield significantly better results (p>0.05) than those with late surgery, more than 6 months.

Conclusions: Secondary surgery for the restoration of external rotation is a rewarding procedure when primary reconstruction was/is not possible.