Brachial Plexus Injury

Introduction

Injury to the brachial plexus nerves is not uncommon in childbirth. For most infants injured in this way, the resulting impairment is mild and temporary. For others, it can be severe and may cause lasting disability. The brachial plexus nerves control the entire arm, including the wrist and hands, so damage to these nerves leads to conditions like Erb’s palsy, which affects the sensation and movement in the arms.

For mild cases of injury, which fortunately includes most affected infants, treatment is no more than gentle physical therapy and time to heal. For those with more serious damage, different types of surgery can help repair damaged nerves and restore some function to the arm.

Procedures

Nerve Graft

Most infants with brachial plexus injury will begin to recover within a few months, with a full recovery by six months. If improvements are not seen or are not adequate by six months, surgery to correct nerve damage may be an option. Surgical treatment for these injuries is only necessary when nerves do not heal on their own.

In the case of a nerve that is overstretched, not healing, or that has been torn, a nerve graft may be performed to repair damage and restore sensation and movement. This involves using a donor’s nerve, typically from another part of the patient’s own body, and grafting it onto the damaged nerve to bypass the tear and promote healing.

Nerve Transfer

In even more severe cases, particularly when the nerve has been torn away from the spinal cord, a nerve transfer may be needed. This also involves a donor nerve, which is used to reconnect the torn nerve to the spinal cord.

In some cases, a nerve transfer may be used instead of a nerve graft for a nerve that is damaged but not separated from the spinal cord. In this case, a transfer can be more targeted than graft and may restore more sensation and movement to the affected muscle.

Other Surgical Treatments

Other types of surgeries may be used to help children with brachial plexus injuries recover more movement or sensation. These may include muscle or tendon transfers. This is most often done when surgery on the nerves is not possible because it has been delayed to the age of 12 months or older.

Severing and reconnecting muscles and tendons can restore some motion to affected arms and joints. Other surgeries that can help a child with brachial plexus injury include surgery to remove scar tissue from damaged nerves, shoulder and elbow reconstructions, and arthroscopic surgeries.

Recovery

The healing time will depend on case-to-case basis and type of surgery is performed.