Brachial Plexus Birth Palsy Injury
Brachial plexus injuries associated with birth are treated at Duke by a team of experts who specialize in helping your child regain strength and movement in his or her arm. We evaluate your child’s injury, monitor nerve recovery and growth, and create a treatment plan that includes physical therapy exercises and surgery when necessary. Our goal is to help your child regain lost feeling and full range of motion.
Team Approach to Birth-Related Brachial Plexus Injury
During a difficult birth, the brachial plexus nerves that run between the neck and shoulder can tear or stretch as the baby comes through the birth canal. Damaged nerves can lead to a loss of feeling and movement from the shoulder to the wrist and fingers. The severity of the injury will determine how much function your child loses. Symptoms can range from minor weakness to complete paralysis.
Fortunately, most brachial plexus injuries are minor and heal on their own, over time. Our team’s experts will evaluate your child soon after birth to determine the severity of the injury and to make sure your child gets the therapy and support he or she needs. As your child grows, one or more of the following experts may be involved in your child’s care.
- Physical and occupational therapists perform a comprehensive assessment of your baby to determine whether exercise can improve muscle strength and range of motion. It’s critical that therapy start as soon as possible to keep joints supple and to keep muscles fit and healthy.
- Neurologists evaluate the extent of your child’s injury at specific age-related milestones. They work closely with physical and occupational therapists to determine if progress is being achieved, and whether and when surgery should be the next step.
- Pediatric plastic surgeons assess whether early surgery to remove scar tissue and replace damaged nerves may restore lost sensation and movement in your child’s shoulder and arm.
- Orthopaedic surgeons may recommend surgery to improve the function of the shoulder, elbow, or wrist by way of tendon-transfer operations. This typically takes place in children who are closer to age two.
BRACHIAL PLEXUS INJURY
We consider all aspects of your child’s condition as we work with you to select the best treatment for your baby.
Ongoing PT/OT can be beneficial in all cases. The exercises prevent your baby’s muscles and joints from tightening and increase your baby’s range of motion. Some babies may only require PT/OT; however, exercises can also help your child regain function after surgery if it is required.
This procedure is typically performed between three and nine months of age when a baby’s nerves do not recover on their own. Pediatric plastic surgeons identify the parts of the brachial plexus that are not working and replace the damaged nerves with a portion of healthy nerve (called grafts) that are taken from your child’s legs. These grafts help new nerves grow out of the spinal cord and down toward the muscles of the shoulder, arm, and hand. Nerve regrowth is a slow process. It may take one year to see significant changes in your child's movements.
This procedure may be performed in addition to, or instead of, reconstructing the brachial plexus. An orthopaedic surgeon transfers healthy muscle and tendons to replace damaged muscle and nerve. It is usually performed in older children (around age two) to improve stability or range of motion in the shoulder. Some tendon transfers may also be useful to improve elbow and wrist function.
BRACHIAL PLEXUS INJURY
Family and Support Services
We understand the emotional impact your baby’s brachial plexus injury can have on your family, so we offer special services to help you through it. You can depend on knowledgeable, compassionate experts at your side.
Whether it's explaining a procedure or offering encouragement and emotional support, we provide care for you and your child in a warm, welcoming environment. We’re here to help you cope as your child goes through treatment and recovery.
It’s helpful to have a team on your side to assist you in managing your child’s care. Our care coordinators and social workers help you navigate the medical system and coordinate the variety of health services your child's needs. They can help you work with insurance providers, connect you with resources, and help you manage the details related to your child’s care. Our nurse coordinators can help you schedule appointments for tests, treatments, and other medical visits.
Enjoy a comfortable place to relax at the hospital. You can grab a light meal, shower, do laundry, or use a computer with internet access. Staffed by volunteers, the family room is here to make your time at the hospital a little more comfortable.