Brachial Plexus Birth Palsy | Diagnosis and Treatment

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How is brachial plexus birth palsy diagnosed?

Brachial plexus birth palsy can be diagnosed by your baby’s pediatrician upon a thorough medical history and physical examination. Since the majority of babies with a brachial plexus injury recover in the first month to six weeks after they’re born, these exams can be scheduled with a primary care doctor. Children who continue to have problems beyond six weeks should be seen by a pediatric orthopedist or brachial plexus specialist.

In addition to a physical exam, doctors may conduct special imaging studies like an MRI or nerve conduction studies — although for babies, these tests are not as reliable as they are for adults. If doctors suspect that your child also has a fracture, they may take an x-ray, too. It’s important to find an experienced doctor who will be able to track your child’s progress over repeated exams.

How is brachial plexus birth palsy treated?

Observation

Most brachial plexus birth palsies will heal on their own. Your doctor will monitor your child closely. Many children improve or recover by 3 to 12 months of age. During this time, ongoing exams should be performed to monitor progress.

Physical therapy or occupational therapy

Therapy is recommended to help maximize use of the affected arm and prevent tightening of the muscles and joints. With the teaching and guidance of therapists, parents learn how to perform range of motion (ROM) exercises at home with their child several times a day. These exercises are important to keep the joints and muscles moving as normally as possible.

Botox® injections

Botox® may be used (mainly for the shoulder) to help with joint motion, rebalance muscles, or prevent contractures and shoulder dislocations.

What are the surgical options for brachial plexus birth palsy?

Children who continue to have problems three to six months after birth may benefit from surgical treatment. Your child's doctors have several surgical options for treating brachial plexus birth palsy, including:

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

Microsurgery to repair or reconstruct the injured nerves is recommended if recovery is still inadequate three to six months after birth. This surgery generally consists of a combination of nerve grafting and nerve transfer procedures. It is best performed between 3 and 9 months of life and is usually not beneficial for children beyond 1 year of age.

Osteotomy

An osteotomy is a procedure in which bones are cut and reoriented to improve upper extremity function by better positioning the hand and arm. It is most commonly performed on the humerus (upper arm bone) or forearm.

Tendon transfers

Tendon transfers involve separating the tendon from its normal attachment and reattaching it to a new location. This procedure, typically performed between age 1 and adulthood, allows a healthy muscle to help a weaker or injured muscle to return to its desired function. Tendon transfers are usually done around the shoulder to improve the ability to raise the arm, but may be done in the forearm, wrist or hand. Children are often in a cast for four to six weeks after surgery. 

Open reduction of the shoulder joint (capsulorraphy)

Open reduction of the shoulder joint, performed through a surgical incision or using arthroscopy, reduces (placing the humeral head back in joint) and surgically tightens loose tissue around the shoulder joint. The procedure is needed when persistent muscle weakness has caused shoulder joint instability or dislocation. It is often performed in conjunction with other surgical procedures.

Free muscle transfers

A free muscle transfer is an extensive surgery, typically using leg muscles, which required reconnection of blood vessels and nerves under microscope. It is performed only when there are no local muscles in the arm or hand to replace dysfunctional muscles.

What is the long-term outlook for brachial plexus birth palsy?

Most young children fully — or nearly fully — recover by the time they're 6 to 12 months old. Some may even begin to recover when they're just 6 weeks old. Less than half of children with brachial plexus birth palsy will need nerve surgery. Some require tendon transfers. The outcomes from these surgeries are favorable for improved long-term function.

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