the important advances of the last 30 years in obstetrical brachial plexus palsy included refinement of diagnosis, improved methods of nerve repair and most importantly, policy of urgent exploration and repair .This study comprises 75 patients classified into two main groups.Group A (25 cases) : It comprises patients who suffered from total obstetrical brachial plexus palsy and operated upon primarily early in their life .Those patients were below the age of two years and showed poor recovery of function.Group B (50 cases) : It comprises patients who have the same problem but missed the chance of surgical treatment (neglected).Comparison between functional outcome after total obstetrical brachial plexus palsy in primarily operated and non operated patients revealed a neurological improvement of functional significance in the operated over the non operated patients which was detected in 76% of cases against 36% in the shoulder joint, 92% of cases against 60% in the elbow, 60% of cases against 28 % in the wrist loint and 48% of cases against 26% in the hand .Time between the injury and its reconstruction was a crucial determinant of the functional result. In longstanding brachial plexus lesions, atrophy of the denervated muscles progresses until reinnervation becomes impossible or can only produce a minor clinically unimportant result.