{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:34:20Z","timestamp":1791261260077,"version":"4.1.0"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Childs Nerv Syst"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Outcomes after brachial plexus birth injury (BPBI) vary widely, highlighting the need for rehabilitation strategies that reliably enhance functional recovery. We hypothesized that a coordinated, interdisciplinary rehabilitation network involving surgeons and occupational therapists improves functional outcomes after spinal accessory to suprascapular nerve (SAN-SSN) transfer. We compared outcomes from two academic centers with similar surgical indications and techniques but distinct rehabilitation models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed 25 infants who underwent SAN-SSN transfer from 2022 to 2024. Institution A used a coordinated multidisciplinary rehabilitation model in which the surgeon partnered directly with specialized therapists. Patients at institution B self-selected therapy sites. Pre- and postoperative external rotation Active Movement Scale (AMS) scores were collected and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both cohorts showed significant improvement in external rotation (ER) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Median postoperative AMS scores were higher at institution A (7; interquartile range [IQR] 5.5\u20137) than at institution B (4; IQR 3\u20135). Functional recovery (AMS\u2009\u2265\u20096) occurred in 72.7% of institution A patients versus 14.3% at institution B (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005). Within institution B, on-site therapy produced significantly better outcomes than off-site therapy. Patients at institution A had 11.8-fold greater odds of achieving higher AMS scores than patients at institution B (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018); these differences were not significant when comparing institution A to institution B\u2019s on-site subgroup.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Surgeon-directed, expert-guided therapy is associated with superior recovery after SAN-SSN transfer for BPBI. These findings support the impact of a scalable model which prioritizes timely, consistent, and coordinated postoperative rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>III, retrospective cohort comparison.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-026-07216-w","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:22:32Z","timestamp":1773724952000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Multidisciplinary rehabilitation network enhances outcomes after nerve transfer in brachial plexus birth injury"],"prefix":"10.1007","volume":"42","author":[{"given":"Alejandro J.","family":"Friedman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Robbins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Gotlieb-Horowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandana","family":"Behbahani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Durham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Meisel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Koehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"7216_CR1","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.2106\/00004623-200309000-00012","volume":"85","author":"DS Bae","year":"2003","unstructured":"Bae DS, Waters PM, Zurakowski D (2003) Reliability of three classification systems measuring active motion in brachial plexus birth palsy. J Bone Joint Surg Am 85:1733\u20131738. https:\/\/doi.org\/10.2106\/00004623-200309000-00012","journal-title":"J Bone Joint Surg Am"},{"key":"7216_CR2","doi-asserted-by":"publisher","first-page":"194","DOI":"10.2106\/JBJS.18.01312","volume":"102","author":"Bauer AS, Kalish LA, Adamczyk MJ, Bae DS, Cornwall R, James MA, Lightdale-Miric N, Peljovich AE, Waters PM, Treatment, Outcomes of Brachial Plexus Injury Study G","year":"2020","unstructured":"Bauer AS, Kalish LA, Adamczyk MJ, Bae DS, Cornwall R, James MA, Lightdale-Miric N, Peljovich AE, Waters PM, Treatment, Outcomes of Brachial Plexus Injury Study G (2020) Microsurgery for brachial plexus injury before versus after 6 months of age: results of the multicenter treatment and outcomes of brachial plexus injury (TOBI) study. J Bone Joint Surg Am 102:194\u2013204. https:\/\/doi.org\/10.2106\/JBJS.18.01312","journal-title":"J Bone Joint Surg Am"},{"key":"7216_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2024.09.025","author":"JA Bertelli","year":"2024","unstructured":"Bertelli JA, Tahir M (2024) Shoulder function reconstruction in brachial plexus birth injury: anterior shoulder release and spinal accessory to suprascapular nerve transfer. J Hand Surg Am. https:\/\/doi.org\/10.1016\/j.jhsa.2024.09.025","journal-title":"J Hand Surg Am"},{"key":"7216_CR4","doi-asserted-by":"publisher","first-page":"144e","DOI":"10.1097\/PRS.0b013e3181a80798","volume":"124","author":"GH Borschel","year":"2009","unstructured":"Borschel GH, Clarke HM (2009) Obstetrical brachial plexus palsy. Plast Reconstr Surg 124:144e\u2013155e. https:\/\/doi.org\/10.1097\/PRS.0b013e3181a80798","journal-title":"Plast Reconstr Surg"},{"key":"7216_CR5","doi-asserted-by":"publisher","first-page":"395","DOI":"10.3171\/2013.6.PEDS12630","volume":"12","author":"KW Chang","year":"2013","unstructured":"Chang KW, Justice D, Chung KC, Yang LJ (2013) A systematic review of evaluation methods for neonatal brachial plexus palsy: a review. J Neurosurg Pediatr 12:395\u2013405. https:\/\/doi.org\/10.3171\/2013.6.PEDS12630","journal-title":"J Neurosurg Pediatr"},{"key":"7216_CR6","doi-asserted-by":"crossref","unstructured":"Clarke HM, Curtis CG (1995) An approach to obstetrical brachial plexus injuries. Hand Clin 11:563\u2013580. discussion 580\u2013561","DOI":"10.1016\/S0749-0712(21)00264-X"},{"key":"7216_CR7","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1177\/17531934241232062","volume":"49","author":"CS Crowe","year":"2024","unstructured":"Crowe CS, Spinner RJ, Shin AY (2024) Global trends and outcomes of nerve transfers for treatment of adult brachial plexus injuries. J Hand Surg Eur Vol 49:1147-1156. https:\/\/doi.org\/10.1177\/17531934241232062","journal-title":"J Hand Surg Eur Vol"},{"key":"7216_CR8","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1053\/jhsu.2002.32965","volume":"27","author":"C Curtis","year":"2002","unstructured":"Curtis C, Stephens D, Clarke HM, Andrews D (2002) The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg Am 27:470\u2013478. https:\/\/doi.org\/10.1053\/jhsu.2002.32965","journal-title":"J Hand Surg Am"},{"key":"7216_CR9","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002290","volume":"7","author":"LF Domeshek","year":"2019","unstructured":"Domeshek LF, Novak CB, Patterson JMM, Hasak JM, Yee A, Kahn LC, Mackinnon SE (2019) Nerve transfers-a paradigm shift in the reconstructive ladder. Plast Reconstr Surg 7:e229010.1097\/GOX.0000000000002290","journal-title":"Plast Reconstr Surg"},{"key":"7216_CR10","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1097\/SAP.0000000000002924","volume":"88","author":"JM Felder","year":"2022","unstructured":"Felder JM, Ducic I (2022) Cross-sectional evaluation of the economic burden on patients seeking surgical treatment for chronic nerve injuries. Ann Plast Surg 88:200\u2013207. https:\/\/doi.org\/10.1097\/SAP.0000000000002924","journal-title":"Ann Plast Surg"},{"key":"7216_CR11","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1097\/BPO.0000000000000699","volume":"37","author":"DA Greenhill","year":"2017","unstructured":"Greenhill DA, Lukavsky R, Tomlinson-Hansen S, Kozin SH, Zlotolow DA (2017) Relationships between 3 classification systems in brachial plexus birth palsy. J Pediatr Orthop 37:374\u2013380. https:\/\/doi.org\/10.1097\/BPO.0000000000000699","journal-title":"J Pediatr Orthop"},{"key":"7216_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2025.05.013","author":"EE Hecox","year":"2025","unstructured":"Hecox EE, Boydstun AG, Talbot HG, Edwards SR, Anderson L, Benedict KC, Walker ME (2025) Geographic disparities in access to certified hand therapists in the United States. J Hand Surg Am. https:\/\/doi.org\/10.1016\/j.jhsa.2025.05.013","journal-title":"J Hand Surg Am"},{"key":"7216_CR13","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1007\/s00381-017-3492-0","volume":"33","author":"CO Heise","year":"2017","unstructured":"Heise CO, Siqueira MG, Martins RS, Foroni LH, Sterman-Neto H (2017) Distal nerve transfer versus supraclavicular nerve grafting: comparison of elbow flexion outcome in neonatal brachial plexus palsy with C5-C7 involvement. Childs Nerv Syst 33:1571-157410.1007\/s00381-017-3492\u20130","journal-title":"Childs Nerv Syst"},{"key":"7216_CR14","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1017\/s0012162204000179","volume":"46","author":"AF Hoeksma","year":"2004","unstructured":"Hoeksma AF, ter Steeg AM, Nelissen RG, van Ouwerkerk WJ, Lankhorst GJ, de Jong BA (2004) Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol 46:76-8310.1017\/s0012162204000179","journal-title":"Dev Med Child Neurol"},{"key":"7216_CR15","doi-asserted-by":"publisher","first-page":"633","DOI":"10.3109\/17453674.2014.964614","volume":"85","author":"G Hulleberg","year":"2014","unstructured":"Hulleberg G, Elvrum AK, Brandal M, Vik T (2014) Outcome in adolescence of brachial plexus birth palsy. 69 individuals re-examined after 10-20 years. Acta Orthop 85:633\u2013640. https:\/\/doi.org\/10.3109\/17453674.2014.964614","journal-title":"Acta Orthop"},{"key":"7216_CR16","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/17531934241276372","volume":"50","author":"M Hyttinen","year":"2025","unstructured":"Hyttinen M, Ronkko H, Paavilainen P, Helminen M, Jokihaara J (2025) Results of spinal accessory nerve to suprascapular nerve transfers in children with brachial plexus birth injury. J Hand Surg Eur Vol 50:362-36910.1177\/17531934241276372","journal-title":"J Hand Surg Eur Vol"},{"key":"7216_CR17","doi-asserted-by":"publisher","first-page":"S71","DOI":"10.1016\/j.apmr.2016.03.015","volume":"97","author":"ME Johanson","year":"2016","unstructured":"Johanson ME (2016) Rehabilitation after surgical reconstruction to restore function to the upper limb in tetraplegia: a changing landscape. Arch Phys Med Rehabil 97:S71-7410.1016\/j.apmr.2016.03.015","journal-title":"Arch Phys Med Rehabil"},{"key":"7216_CR18","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.hcl.2015.12.014","volume":"32","author":"LC Kahn","year":"2016","unstructured":"Kahn LC, Moore AM (2016) Donor activation focused rehabilitation approach: maximizing outcomes after nerve transfers. Hand Clin 32:263\u2013277. https:\/\/doi.org\/10.1016\/j.hcl.2015.12.014","journal-title":"Hand Clin"},{"key":"7216_CR19","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.jhsa.2023.09.016","volume":"49","author":"LC Kahn","year":"2024","unstructured":"Kahn LC, Stonner MM, Dy CJ (2024) Key considerations for nerve transfer rehabilitation after surgical reconstruction for brachial plexus and peripheral nerve injuries. J Hand Surg Am 49:160\u201316810. https:\/\/doi.org\/10.1016\/j.jhsa.2023.09.016","journal-title":"J Hand Surg Am"},{"key":"7216_CR20","doi-asserted-by":"publisher","first-page":"225e","DOI":"10.1097\/PRS.0000000000012041","volume":"156","author":"N Khabyeh-Hasbani","year":"2025","unstructured":"Khabyeh-Hasbani N, Robbins V, Gotlieb-Horowitz M, Behbahani M, Meisel E, Koehler SM (2025) Redefining the incidence of infantile glenohumeral dysplasia following brachial plexus birth injury. Plast Reconstr Surg 156:225e\u2013232e. https:\/\/doi.org\/10.1097\/PRS.0000000000012041","journal-title":"Plast Reconstr Surg"},{"key":"7216_CR21","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1097\/00004694-200403000-00011","volume":"24","author":"SH Kozin","year":"2004","unstructured":"Kozin SH (2004) Correlation between external rotation of the glenohumeral joint and deformity after brachial plexus birth palsy. J Pediatr Orthop 24:189\u2013193. https:\/\/doi.org\/10.1097\/00004694-200403000-00011","journal-title":"J Pediatr Orthop"},{"key":"7216_CR22","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.ocl.2021.11.003","volume":"53","author":"JS Lin","year":"2022","unstructured":"Lin JS, Samora JB (2022) Brachial plexus birth injuries. Orthop Clin North Am 53:167\u2013177. https:\/\/doi.org\/10.1016\/j.ocl.2021.11.003","journal-title":"Orthop Clin North Am"},{"key":"7216_CR23","doi-asserted-by":"publisher","first-page":"298","DOI":"10.2106\/JBJS.19.00627","volume":"102","author":"MC Manske","year":"2020","unstructured":"Manske MC, Kalish LA, Cornwall R, Peljovich AE, Bauer AS (2020) Reconstruction of the suprascapular nerve in brachial plexus birth injury: a comparison of nerve grafting and nerve transfers. J Bone Joint Surg Am 102:298\u2013308. https:\/\/doi.org\/10.2106\/JBJS.19.00627","journal-title":"J Bone Joint Surg Am"},{"key":"7216_CR24","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1002\/jor.22709","volume":"32","author":"VV Mascarenhas","year":"2014","unstructured":"Mascarenhas VV, Casaccia M, Fernandez-Martin A, Marotta M, Fontecha CG, Haddad S, Knorr J, Soldado F (2014) The role of subscapularis muscle denervation in the pathogenesis of shoulder internal rotation contracture after neonatal brachial plexus palsy: a study in a rat model. J Orthop Res 32:1675\u2013167910. https:\/\/doi.org\/10.1002\/jor.22709","journal-title":"J Orthop Res"},{"key":"7216_CR25","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1055\/s-0041-1731255","volume":"54","author":"S Maurya","year":"2021","unstructured":"Maurya S, Renganathan G, R V, Bharti R (2021) Outcomes of shoulder functions in spinal accessory to suprascapular nerve transfer in brachial plexus injury: a comparison between anterior and posterior approach. Indian J Plast Surg 54:152\u201315610. https:\/\/doi.org\/10.1055\/s-0041-1731255","journal-title":"Indian J Plast Surg"},{"key":"7216_CR26","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.jhsg.2020.10.003","volume":"3","author":"M Morris","year":"2021","unstructured":"Morris M, Brogan DM, Boyer MI, Dy CJ (2021) Trends in nerve transfer procedures among board-eligible orthopedic hand surgeons. J Hand Surg Glob Online 3:24\u20132910. https:\/\/doi.org\/10.1016\/j.jhsg.2020.10.003","journal-title":"J Hand Surg Glob Online"},{"key":"7216_CR27","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002803","author":"WE Muhlestein","year":"2023","unstructured":"Muhlestein WE, Chang KW, Justice D, Nelson VS, Saadeh YS, Smith BW (2023) Impact of timing of primary nerve surgery on shoulder, forearm, and elbow recovery in neonatal brachial plexus palsy. Neurosurgery. https:\/\/doi.org\/10.1227\/neu.0000000000002803","journal-title":"Neurosurgery"},{"key":"7216_CR28","doi-asserted-by":"publisher","first-page":"e180","DOI":"10.1016\/j.wneu.2021.12.111","volume":"160","author":"B Nguyen","year":"2022","unstructured":"Nguyen B, Parikh P, Singh R, Patel N, Noland SS (2022) Trends in peripheral nerve surgery: workforce, reimbursement, and procedural rates. World Neurosurg 160:e180\u2013e188. https:\/\/doi.org\/10.1016\/j.wneu.2021.12.111","journal-title":"World Neurosurg"},{"key":"7216_CR29","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1177\/15589447211030691","volume":"18","author":"KJ Nickel","year":"2023","unstructured":"Nickel KJ, Morzycki A, Hsiao R, Morhart MJ, Olson JL (2023) Nerve transfer is superior to nerve grafting for suprascapular nerve reconstruction in obstetrical brachial plexus birth injury: a meta-analysis. Hand N Y 18:385\u2013392. https:\/\/doi.org\/10.1177\/15589447211030691","journal-title":"Hand N Y"},{"key":"7216_CR30","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1111\/sae.12003","volume":"6","author":"M Nixon","year":"2014","unstructured":"Nixon M, Trail I (2014) Management of shoulder problems following obstetric brachial plexus injury. Shoulder Elbow 6:12\u201317. https:\/\/doi.org\/10.1111\/sae.12003","journal-title":"Shoulder Elbow"},{"key":"7216_CR31","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1097\/PRS.0000000000003668","volume":"140","author":"KM O'Grady","year":"2017","unstructured":"O\u2019Grady KM, Power HA, Olson JL, Morhart MJ, Harrop AR, Watt MJ, Chan KM (2017) Comparing the efficacy of triple nerve transfers with nerve graft reconstruction in upper trunk obstetric brachial plexus injury. Plast Reconstr Surg 140:747\u201375610. https:\/\/doi.org\/10.1097\/PRS.0000000000003668","journal-title":"Plast Reconstr Surg"},{"key":"7216_CR32","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1227\/01.neu.0000170557.13788.d2","volume":"57","author":"W Pondaag","year":"2005","unstructured":"Pondaag W, de Boer R, van Wijlen-Hempel MS, Hofstede-Buitenhuis SM, Malessy MJ (2005) External rotation as a result of suprascapular nerve neurotization in obstetric brachial plexus lesions. Neurosurgery 57:530\u2013537. https:\/\/doi.org\/10.1227\/01.neu.0000170557.13788.d2","journal-title":"Neurosurgery"},{"key":"7216_CR33","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1017\/s0012162204000258","volume":"46","author":"W Pondaag","year":"2004","unstructured":"Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT (2004) Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol 46:138\u201314410. https:\/\/doi.org\/10.1017\/s0012162204000258","journal-title":"Dev Med Child Neurol"},{"key":"7216_CR34","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1080\/02688697.2019.1639620","volume":"34","author":"K Rezzadeh","year":"2020","unstructured":"Rezzadeh K, Donnelly M, Vieira D, Daar D, Shah A, Hacquebord J (2020) The extent of brachial plexus injury: an important factor in spinal accessory nerve to suprascapular nerve transfer outcomes. Br J Neurosurg 34:591\u2013594. https:\/\/doi.org\/10.1080\/02688697.2019.1639620","journal-title":"Br J Neurosurg"},{"key":"7216_CR35","doi-asserted-by":"publisher","unstructured":"Robbins V, Khabyeh-Hasbani N, Meisel EM, Behbahani M, Koehler SM (2025) A comparison of end-to-end versus reverse end-to-side nerve transfer techniques in treating brachial plexus birth injury-associated glenohumeral dysplasia. Hand (N Y): 15589447251350164. https:\/\/doi.org\/10.1177\/15589447251350164","DOI":"10.1177\/15589447251350164"},{"key":"7216_CR36","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1016\/j.jhsa.2019.02.004","volume":"44","author":"D Segal","year":"2019","unstructured":"Segal D, Cornwall R, Little KJ (2019) Outcomes of spinal accessory-to-suprascapular nerve transfers for brachial plexus birth injury. J Hand Surg Am 44:578\u2013587. https:\/\/doi.org\/10.1016\/j.jhsa.2019.02.004","journal-title":"J Hand Surg Am"},{"key":"7216_CR37","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1097\/PRS.0000000000001096","volume":"135","author":"M Seruya","year":"2015","unstructured":"Seruya M, Shen SH, Fuzzard S, Coombs CJ, McCombe DB, Johnstone BR (2015) Spinal accessory nerve transfer outperforms cervical root grafting for suprascapular nerve reconstruction in neonatal brachial plexus palsy. Plast Reconstr Surg 135:1431\u20131438. https:\/\/doi.org\/10.1097\/PRS.0000000000001096","journal-title":"Plast Reconstr Surg"},{"key":"7216_CR38","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3171\/2020.6.PEDS2027","volume":"27","author":"BW Smith","year":"2021","unstructured":"Smith BW, Chang KWC, Koduri S, Yang LJS (2021) Nerve graft versus nerve transfer for neonatal brachial plexus: shoulder outcomes. J Neurosurg Pediatr 27:87\u201392. https:\/\/doi.org\/10.3171\/2020.6.PEDS2027","journal-title":"J Neurosurg Pediatr"},{"key":"7216_CR39","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1001\/jamapediatrics.2018.0124","volume":"172","author":"BW Smith","year":"2018","unstructured":"Smith BW, Daunter AK, Yang LJ, Wilson TJ (2018) An update on the management of neonatal brachial plexus palsy-replacing old paradigms: a review. JAMA Pediatr 172:585\u2013591. https:\/\/doi.org\/10.1001\/jamapediatrics.2018.0124","journal-title":"JAMA Pediatr"},{"key":"7216_CR40","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000012418","author":"F Soldado","year":"2025","unstructured":"Soldado F, Rojas-Neira J, Gonzalez-Morgado D, De Avila-Diaz I, Levaro-Pano F, Bertelli JA (2025) Very late spinal accessory nerve to infraspinatus nerve transfer to restore glenohumeral external rotation in brachial plexus birth injury. Plast Reconstr Surg. https:\/\/doi.org\/10.1097\/PRS.0000000000012418","journal-title":"Plast Reconstr Surg"},{"key":"7216_CR41","doi-asserted-by":"publisher","first-page":"e370","DOI":"10.1097\/PRS.0b013e3181bcf01f","volume":"124","author":"JK Terzis","year":"2009","unstructured":"Terzis JK, Kokkalis ZT (2009) Pediatric brachial plexus reconstruction. Plast Reconstr Surg 124:e370\u2013e385. https:\/\/doi.org\/10.1097\/PRS.0b013e3181bcf01f","journal-title":"Plast Reconstr Surg"},{"key":"7216_CR42","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1111\/dmcn.14381","volume":"62","author":"R Van der Looven","year":"2020","unstructured":"Van der Looven R, Le Roy L, Tanghe E, Samijn B, Roets E, Pauwels N, Deschepper E, De Muynck M, Vingerhoets G, Van den Broeck C (2020) Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol 62:673\u2013683. https:\/\/doi.org\/10.1111\/dmcn.14381","journal-title":"Dev Med Child Neurol"},{"key":"7216_CR43","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1177\/15589447231167582","volume":"19","author":"K Varagur","year":"2024","unstructured":"Varagur K, Jacobson L, Teixeira R, Patterson JMM, Skolnick GB, Mackinnon SE (2024) Following a surgical paradigm shift through the adoption of nerve transfers among board-eligible and practicing plastic surgeons. Hand (N Y) 19:1044\u20131053. https:\/\/doi.org\/10.1177\/15589447231167582","journal-title":"Hand (N Y)"},{"key":"7216_CR44","doi-asserted-by":"publisher","DOI":"10.1016\/j.jham.2025.100325","volume":"17","author":"R Victoria","year":"2025","unstructured":"Victoria R, Nathan KH, Devon O, Mandana B, Erin M, Koehler SM (2025) Analyzing socioeconomic characteristics in brachial plexus birth injuries: a multicenter public health analysis. J Hand Microsurg 17:100325. https:\/\/doi.org\/10.1016\/j.jham.2025.100325","journal-title":"J Hand Microsurg"},{"key":"7216_CR45","doi-asserted-by":"publisher","first-page":"205","DOI":"10.5435\/00124635-199707000-00004","volume":"5","author":"PM Waters","year":"1997","unstructured":"Waters PM (1997) Obstetric brachial plexus injuries: evaluation and management. J Am Acad Orthop Surg 5:205\u2013214. https:\/\/doi.org\/10.5435\/00124635-199707000-00004","journal-title":"J Am Acad Orthop Surg"},{"key":"7216_CR46","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004346","volume":"10","author":"ME Wells","year":"2022","unstructured":"Wells ME, Tihista MC, Diamond S (2022) Brachial plexus birth injury: trends in early surgical intervention over the last three decades. Plast Reconstr Surg Glob Open 10:e4346. https:\/\/doi.org\/10.1097\/GOX.0000000000004346","journal-title":"Plast Reconstr Surg Glob Open"}],"container-title":["Child's Nervous System"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-026-07216-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00381-026-07216-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-026-07216-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T18:04:36Z","timestamp":1773770676000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00381-026-07216-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["7216"],"URL":"https:\/\/doi.org\/10.1007\/s00381-026-07216-w","relation":{},"ISSN":["1433-0350"],"issn-type":[{"value":"1433-0350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]},"assertion":[{"value":"4 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval for this study was obtained from the Einstein Institutional Review Board (IRB #2024\u201316479).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"121"}}