Table 5.

Combined Classification of Perinatal Brachial Plexus Injury

Group	Name	Roots or spinal nerves injured	Weakness/ Paralysis at 2–3 weeks of age	Condition at 2 months of age	Likely Outcome
I	Upper Erb’s Palsy	C5, C6	Shoulder abduction/external rotation, elbow flexion	Variable recovery of shoulder/elbow motion	Good spontaneous recovery in > 80% of cases
IIa	Extended Erb’s Palsy with early recovery of wrist extension	C5, C6, C7	As above with wrist drop	As above with active wrist extension	Good spontaneous recovery in > 60% of cases
IIb	Extended Erb’s Palsy with no early recovery of wrist extension	C5, C6, C7	As above with wrist drop	As above. No active wrist extension	Good spontaneous recovery in > 60% of cases
III	Global palsy with no Horner’s Syndrome	C5 to C8, T1	Complete flaccid paralysis	Variable recovery of arm motion. No Horner’s Syndrome.	Good spontaneous recovery of shoulder/elbow in > 30–50% of cases. Functional hand frequently noted.
IV	Global palsy with Horner’s Syndrome	C5 to C8, T1	Complete flaccid paralysis with Horner Syndrome	Variable recovery of arm motion. Horner’s syndrome may be present.	Without surgery severe arm deficits are expected.

1) Narakas AO. Obstetrical brachial plexus injuries. In Lamb DW (Ed), The Paralyzed Hand. New York: Churchill Livingstone, 1987, 116–135. 2) Al-Qattan MM, El-Sayed AAF, Al-Zahrani AY, et al. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg [Eur]. 2009;34:788-91.