Brachial Plexus Treatment

Babies are usually diagnosed with a brachial plexus injury within the first 24 hours after birth. The need for treatment will depend on the severity of the injury. The baby should be evaluated soon after birth and followed by a doctor or medical team who is experienced in treating these injuries. Immediate evaluation should occur regardless of function at the time of injury. In many facilities a team of specialists will evaluate the child at regular intervals to be sure that all aspects of the injury are addressed. A brachial plexus team may consist of a combination of plastic surgeons, hand and wrist surgeons, orthopedic surgeons, neurologists, reconstructive micro surgeons, rehabilitation specialists, occupational therapists, physical therapists, and behavioral therapists among others.

Early Treatment should include range of motion exercises to help keep the baby's muscles toned and flexible while waiting for the nerves to heal. The parents can be taught how to properly exercise the arm beginning at about two weeks of age. Stretching and moving the arm, wrist, hand and fingers is important to keep the muscles from shortening and causing a permanent contracture (tightening) of the joints and muscles.

Physical/Occupational Therapy may be needed to help strengthen the arm and help with coordination and mobility. It may also be necessary to help teach the child alternate methods for day-to-day functions such as brushing their hair or dressing themselves. Various types of splinting, massage therapy, pool therapy and electrical stimulation may be used as well.

Surgery is needed in more severe cases to repair injured nerves or reposition muscles so that the muscles can work better as a group. Some surgeries are done as early as 4-6 month of age to maximize the potential for recovery. Optimal results may not be possible, as the child gets older. Even with surgical intervention, a complete recovery may not be likely. The main goal is to improve function as much as possible in the affected arm.

Outcomes

Some brachial plexus injuries will heal with time and restore normal function if treated properly. Other injuries will cause permanent disfiguration and loss of function to some degree. Children with permanent injuries may have arms that won't full straighten, hands that will not rotate or grasp, among other limitations. Early treatment can give these children the best chance to use their arms as well as possible.

If you are expecting or plan to become pregnant, talk to your obstetrician or midwife about shoulder dystocia and brachial plexus injury. ask about their experience handling this complication and the hospital protocol that would be followed if shoulder dystocia does occur. Shoulder dystocia drills are practiced by obstetrical staff in some birthing facilities to help prepare for an emergency.

If you have given birth to a child who suffered a brachial plexus injury or have encountered a shoulder dystocia or other trauma during a previous birth, your chances of delivering a child with a brachial plexus injury will be significantly higher. Cesarean delivery will be necessary to prevent injury during a subsequent delivery. Talk to you practitioner about which method of delivery is safest for you and your baby. Your history from previous pregnancies should be carefully reviewed to determine your risk for complications. Your practitioner should be willing to let you take an active roll in the decision making process during pregnancy and labor.