Brachial Plexus Program | Surgical Options

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Contact the Brachial Plexus Program

  • 617-355-6021
  • International: +1-617-355-5209
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What are the surgical options for brachial plexus birth palsy?

Children who continue to have problems after they’re 3 to 6 months old may benefit from one of several surgical options.

Microsurgery

(10 to 20 percent of all brachial plexus birth palsy surgery)

•   Recommended if recovery is still inadequate three to six months after birth
•   To repair or reconstruct the injured nerves
•   Can be “nerve grafts,” usually from the leg (sural nerves) between nerve root and nerve to muscle
•   Can be “nerve transfers” from other areas of the brachial plexus (or other areas of the body): for more serious
    brachial plexus birth palsy (avulsion)
•   Nerve reconstruction is best performed between 3 and 9 months of life and is usually not beneficial for children
    beyond 1 year of age

Tendon transfers

•   Involves separating the tendon from its normal attachment and reattaching it to a new location
•   Allows a healthy muscle to help a weaker or injured muscle perform its desired function
•   Usually performed around the shoulder to improve the ability to raise the arm, but may be used in forearm,
    wrist or hand
•   Done between 1 year of age and adulthood
•   Patients usually in a cast for four to six weeks after surgery
•   Extensive post-operative therapy
•   In some cases, shoulder weakness may cause limitations in motion that aren’t amenable to tendon transfers

Open reduction of the shoulder joint (capsulorraphy)

•   Reducing (placing the humeral head back in joint) and surgically tightening loose tissue around the shoulder
    joint
•   Usually performed when persistent muscle weakness has caused shoulder joint instability or dislocation
•   Performed through a surgical incision (“open”) -or- using arthroscopy (pencil-sized camera is inserted into the
    shoulder via smaller incisions)
•   Often performed in conjunction with other surgical procedures

Osteotomy

•   Procedure in which bones are cut and reoriented
•   May improve upper extremity function by better positioning the hand and arm
•   Most commonly performed on the humerus (upper arm bone) or forearm

Free muscle transfers

•   Typically using muscle (gracilis) from patient’s leg(s)
•   Extensive surgery requiring reconnection of blood vessels and nerves under microscope
•   Used only when there are no local muscles in the arm or hand to replace dysfunctional muscles

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