Medical Overview - Brachial Plexus Injury Australia

Treatment of Obstetric Brachial Plexus Injuries

Information courtesy of The BC Childrens Hospital in Vancouvr, British Columbia

What treatments are available?

Time

The most important factor in healing of brachial plexus injuries is time. Injured nerves will often repair themselves well enough to allow close to full use of the arm. You will notice a gradual improvement in both the movement and strength in your child’s arm, with most nerve and muscle recovery occurring in the first year of life. Further recovery may happen in the second year, but the effects of increased muscle strength may be much more subtle and difficult to see. Often there is some long term difference between the two arms even when the recovery is considered excellent.

Physiotherapy

Physiotherapy should be started early in the newborn who has a brachial plexus injury. Therapy will not help the nerves themselves heal any faster but it can help prevent problems such as joint stiffness and delays in development. The therapist will instruct parents in the proper handling of the baby and about the safest and most comfortable sleeping positions. Parents will also be taught exercises to help keep the baby’s joints and muscles supple and strengthen muscles that are beginning to work.

Surgery

In some patients, surgery may be recommended if particular arm movements have not recovered within a length of time we know will make full recovery difficult. Children with brachial plexus injuries are carefully monitored during the first year of life to record changes in muscle strength. If the muscle does not strengthen beyond a certain point by a certain age, and the child’s ability to move and use the arm is limited, then the surgeon may suggest an operation. Surgery done directly on the nerves of the brachial plexus is usually done between 3 and 9 months of age depending on the severity. In some patients, where there is a strong imbalance of muscles around the joints, we use injections of Botox (see additional handouts for more information) into the stronger muscles and use positioning devices such as a cast or splint to support the arm, allowing time for the weaker muscles to catch up. Older children who continue to have major movement problems that limit the use of their arm may benefit from other surgical procedures on the muscles and tendons in the affected arm. Examples include tendon transfers, rotation of bone alignment and muscle transplants.

Occupational Therapy

Occupational therapists support the team in helping your child to maintain the range of motion of the arm joints as the nerves recover. This may include specific positioning devices, such as splints or wraps, to help maintain muscles in their lengthened positions. In older children, occupational therapists evaluate and treat children to help them feed, dress and take care of themselves, and participate in school and leisure activities to the best of their abilities. The occupational therapist is able to guide the surgeon by defining problems in the use of the arm when surgery is being considered in the older child.