Brachial Plexus

Overview

A brachial plexus injury is a nerve injury that can cause muscle weakness in your child’s arm or hand. It can affect everyday activities such as play, school and self-care. The brachial plexus is a network of nerves that originate in the spinal cord and extend through the neck, shoulder, and arm. These nerves control the movement and sensation of the upper extremities, including the shoulder, arm, and hand. Injuries to the brachial plexus can occur due to a variety of causes, including traumatic injuries, birth injuries, and tumors.
There are several different types of brachial plexus injuries, and the severity of the injury can vary greatly. Traumatic brachial plexus injuries are typically caused by high-energy injuries, such as motor vehicle accidents, falls, or sports injuries. In these cases, the injury often involves damage to the brachial nerve roots, which can result in a complete loss of muscle function in the affected limb. The most common types of brachial plexus injuries include:

• Neurapraxia: This is the least severe type of brachial plexus injury, and it involves a temporary disruption of the nerve fibers. Symptoms of neuropraxia include weakness, numbness, and tingling in the affected limb, and it often resolves on its own within a few weeks or months.
• Neuropraxia: This type of injury is also considered to be less severe, it involves a disruption of the nerve fibers but it takes longer to heal, it can take several months to recover.
• Rupture: This type of injury involves a complete tearing of the nerve fibers. In this case, the nerve fibers are completely separated, and there is no connection between the nerve and the muscle. Symptoms of a rupture include complete loss of muscle function in the affected limb.
• Avulsion: This is the most severe type of brachial plexus injury, and it involves the detachment of the nerve from the spinal cord. This type of injury is often caused by a traumatic injury, such as a motor vehicle accident, and the prognosis for recovery is poor.

Medical Causes

The brachial plexus is a bundle of nerves in the neck area of the spinal cord, and it can be injured in different ways. In children, brachial plexus is most commonly caused by birth injury.
 

Treatment

Treatment for brachial plexus injuries depends on the severity of the injury and the specific nerves that are affected. In some cases, nerve repair is possible, which involves surgically repairing the damaged nerve fibers. In cases of severe injury, nerve grafts or nerve transfers may be used to restore function.

One of the most common nerve transfers for brachial plexus injuries is the thoracic nerve, which is often used to restore function to the arm and hand. The thoracic nerve is transferred to the affected nerves and connected to the remaining healthy nerve fibers, allowing you to regain some muscle function.

Another surgical option is nerve graft, which is a procedure in which a healthy nerve from another part of the body is grafted onto the damaged nerve fibers. The graft, which acts as a bridge, helps to restore nerve function to the affected area. This can be done to repair injury caused by trauma or to correct congenital defects.

There are a variety of surgical approaches, including nerve transfers and nerve grafts to restore nerve function. The approach chosen depends on the type and severity of the injury, as well as the goals of the surgery. The outcome can vary depending on the level of injury, patient factors and surgical technique used, it may take months or even years to regain full function.

Rehabilitation following a brachial plexus nerve graft is an important part of the recovery process. The goal of rehabilitation is to regain as much strength, range of motion, and function as possible in the affected arm, shoulder, and hand.

Conservative treatments for this type of injury may include:

• Physical or occupational therapy to improve strength and mobility
• Bracing to provide a stretch and help maintain or improve range of motion

Our therapists may recommend specialized brachial plexus treatment such as splinting, massage, kinesiotape, pool therapy, threshold electrical stimulation (TES) or neuromuscular electrical stimulation (NMES).

Your child may be referred for surgical consultation if the injury is more severe and not expected to improve with conservative treatments.

Mary Free Bed Kids brachial plexus rehabilitation services are available with a prescription from your child’s physician.
 
Physical therapy is typically a key component of rehabilitation after a brachial plexus nerve graft. Your Mary Free Bed therapist will work with you to improve range of motion, strength, and coordination in the affected arm and hand. This may include exercises to stretch and strengthen the muscles, as well as activities to improve fine motor skills, such as gripping and grasping.

At Mary Free Bed Rehabilitation Hospital, occupational therapy may also be used to help you learn new ways to perform daily activities, such as dressing, grooming, and eating, using the affected arm.

The timing of the start of rehabilitation depends on the type of surgery and your healing process. Typically, it starts a few weeks after the surgery and gradually increases in intensity and duration as your condition improves. It’s also important to keep in mind that recovery can take extended periods of time and may require additional medical interventions. Your Mary Free Bed therapist will work with you to set realistic goals and to develop an individualized treatment plan that takes into account your specific needs and abilities.
 

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