Types of brachial plexus nerve injuries
Depending on the severity, the injury can cause your child to have various degrees of muscle weakness. There are four different types of nerve injuries to the brachial plexus.
- avulsion - The nerve roots are torn from the spinal cord. If a droopy eyelid is noted on the affected side, this may indicate a more severe injury. This type of injury is less common.
- rupture - The nerve is torn but not where it attaches to the spine.
- neuroma - The nerve has tried to heal, but scar tissue has formed and presses against the injured nerve or interferes with nerve function.
- stretch- The nerve has been damaged but not torn, and usually heals itself within 3 months of life. This injury is most common. These stretch injuries are also known as "neurapraxia".
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Some brachial plexus injuries may heal on their own (spontaneous recovery). Many children improve or recover by 3-12 months of age.
Initial treatment for brachial plexus injuries includes occupational and physical therapy.
Therapists will work with you and your child to learn exercises. Most parents perform range of motion (ROM) exercises at home with their child many times a day for several years.
These exercises are important to keep the joints and muscles moving as normally as possible. Surgery is another treatment which may be indicated when there is inadequate recovery.
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Nerve Surgery
If there is no improvement over the first 3-6 months of life, microsurgery (which
involves operating on small nerves using a surgical microscope) may be
helpful. However, nerve surgery will not completely restore normal
function or help infants over the age of one years old. Some children, after nerve surgery, continue to have some weakness in the shoulder, arm or hand.
If your child has difficulty raising their hand over their head, turning their hand
palm up, or to extend their wrist, further surgery may be indicated.
Tendon Transfer
In some cases a surgical procedure called a tendon transfer (tendons are the connective tissue between the muscle and bone) may be performed. It involves
separating the tendon from its normal attachment and reattaching it in a different
place, often improving shoulder and wrist motion as well as elbow position
and handgrip.
Tendon transfers are done between the age of one year and adulthood, as appropriate. This type of procedure utilizes extensive therapy, which can continue
up to one year postoperatively. The patient can expect to be in a cast around 6 weeks and subsequently utilizes nighttime splints for up to 6 months.
Osteotomy
In some instances, shoulder weakness and/or joint deformity may cause limitations in motion that are not amenable to tendon transfers.
An osteotomy is a surgical procedure in which bones are cut and reoriented,
which may improve upper extremity function.
Capsulorraphy
Capsulorraphy refers to the surgical tightening of loose tissue around the
shoulder joint. This procedure may be performed through a surgical incision
(open capsulorraphy) or with the use of arthroscopy, in which a pencil-sized
camera and instruments are inserted into the shoulder via small incisions. Capsulorraphy may be
performed in combination with tendon lengthenings, in which tight muscles
and tendons are surgically stretched to a more normal length.
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