Children showing little or no spontaneous recovery by the age of 3 months should undergo EMG nerve-conduction studies and spinal-canal imaging by MRI or CT myelography. The latter is useful to identify pseduomeningoceles at the site of nerve root avulsion. Brachial plexus exploration is undertaken with intraoperative EMG nerve-conduction testing. Involved brachial plexus elements may be surgically treated with neurolysis, neuroma excision and nerve grafting as indicated. Eighty percent to 90% of children with Erb's palsy will attain good or excellent functional shoulder recovery with expectant and/or operative management.
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