Treatment of brachial plexus injuries

The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm, and hand. 

What causes it?

Most brachial plexus injuries happen during birth, although a brachial plexus injury can occur at any time. Many babies with brachial plexus injuries are larger than average at birth. However, newborns of all sizes can have these injuries, even premature babies.

The injury occurs when the baby is passing through the birth canal. The baby's shoulders may become impacted, causing the brachial plexus nerves to stretch or tear.

Approximately 2 babies in 1,000 suffer brachial plexus injuries at birth. About 1 in 10 of these babies need surgical treatment, with the others recovering full nerve function through therapeutic exercises alone.

Brachial plexus injuries also occur in children or adults due to trauma to the neck or shoulder region, commonly from motorcycle or motor-vehicle accidents.

Symptoms may include a limp or paralyzed arm, lack of muscle control in the arm, hand, or wrist, and lack of feeling or sensation in the arm or hand. There are four types of brachial plexus injuries: avulsion, the most severe type, in which the nerve is torn from the spine; rupture, in which the nerve is torn but not at the spinal attachment; neuroma, in which the nerve has tried to heal itself but scar tissue has grown around the injury, putting pressure on the injured nerve and preventing the nerve from conducting signals to the muscles; and neuropraxia or stretch, in which the nerve has been damaged but not torn. Neuropraxia is the most common type of brachial plexus injury.

Children with brachial plexus injuries are affected in different ways. Here are some examples:

• Some children have no muscle control and no feeling in their arm or hand.
• Some children can move their arm but have little control over the wrist and hand.
• Other children can use their hand well but cannot use the shoulder or elbow muscles.

Specifically, at 3 months of age, if your child cannot: squeeze your fingers bend their wrist bend and straighten their elbow, or raise their arm it is recommended that you seek a referral to a brachial plexopathy clinic for further evaluation. Treatment for brachial plexus injuries is most effective when initiated between 3 and 6 months of age.

Treatment

Some brachial plexus injuries may heal on their own.  However, there are two main treatments for brachial plexus injuries:

• physical or occupational therapy exercises
• surgery plus therapy exercises

Most children will regain full use of their motor function through therapy alone. For those children who do not regain their motor function by 3-6 months of age, nerve surgery can be an effective treatment to improve arm function following a brachial plexus injury.

Questions and referrals can be directed to (717) 531-0857.

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