Full recovery will occur only if sensory fibers reach their sensory end targets and motor fibers reach their muscle targets. The ability to bend the elbow biceps function by the third month of life is an indicator of probable recovery.
In addition to bicep function, active movement of the wrist in upward motion as well as thumb and fingers straightening is an even stronger indicator of excellent spontaneous improvement. Gentle range of motion exercises performed by parents, along with repeated exams by the doctor, may be all that is necessary for patients with strong indicators of recovery. About two-thirds of children with brachial plexus birth injury get better on their own with minimal treatment.
The remaining patients may have limitations related to their brachial plexus birth injury that are not resolving. Limitations may include incomplete range of motion with one or more movements, weak muscles, or decreased sensation feeling through the arm. It is for these children that the remainder of our treatment efforts are focused. The timeframe of surgical repair is an important factor in recovery.
Within 18 months, the muscles that have not already connected to nerves may have weakened to the point where it is no longer possible. For avulsion and rupture injuries, there is no potential for full recovery unless surgical repair is done in a timely manner. For neuroma and neurapraxia injuries, the potential for improvement varies. Most patients with neurapraxia injuries have a fair prognosis of recovering spontaneously with a percent return of function.
If surgery is needed, microsurgical nerve repair may be undertaken as early as three months post injury. Primary nerve repair is typically completed by approximately six months of age following the injury. When the neuroma is large it must be removed and the nerve is then reattached either with end-to-end techniques or with nerve grafts. When the gap between the nerve ends is so large that it is not possible to have a tension-free repair using the end-to-end technique, nerve grafting is used.
This is used generally in those cases where there is an avulsion. Donor nerves are used for the repair. The parts of the roots still attached to the spinal cord can be used as donors for avulsed nerves.
Because your child may not be able to move the affected arm alone, it is important for you to take an active part in keeping the joints limber. Types of nerve damage A cross section of spine on left shows how nerve roots are connected to the spinal cord. Request an Appointment at Mayo Clinic.
Share on: Facebook Twitter. Show references Winn RH, ed. Early management of brachial plexus injuries. In: Youmans and Winn Neurological Surgery. Elsevier; Accessed Feb. Brachial plexus injuries. American Academy of Orthopaedic Surgeons.
Bromberg MB. Brachial plexus syndromes. Brachial plexus injury. Mayo Clinic; Burners and stingers. Kliegman RM, et al. Birth brachial plexus palsy. In: Nelson Textbook of Pediatrics. Philadelphia, Pa. Spinner RJ expert opinion.
Mayo Clinic. This scar tissue is called a neuroma, and it may result in a painful knot on one of the brachial plexus nerves. Treatment for brachial plexus neuromas includes surgical removal of the scarred nerve tissue. The surgeon then either caps the nerve or attaches it to another nerve to prevent another neuroma from forming. Also called Parsonage Turner syndrome, brachial neuritis is a rare, progressive disorder of the nerves of the brachial plexus.
This syndrome causes sudden, severe shoulder and upper arm pain and progresses from pain to weakness, muscle loss and even loss of sensation. This syndrome usually affects the shoulder and arm, but it can also affect the legs and diaphragm.
The cause of brachial neuritis is unknown, but could be related to an autoimmune response triggered by infections, injury, childbirth or other factors. A brachial plexus avulsion occurs when the root of the nerve is completely separated from the spinal cord. This injury is usually caused by trauma, such as a car or motorcycle accident. More severe than ruptures, avulsions often cause severe pain.
Because it is difficult and usually impossible to reattach the root to the spinal cord, avulsions can lead to permanent weakness, paralysis and loss of feeling. In babies, the brachial plexus nerves in the shoulder are vulnerable during birth. Injury to the brachial plexus is fairly common during birth, occurring in one to two births per 1, Larger babies in difficult vaginal deliveries are particularly prone to this injury, as are babies of mothers who have diabetes.
During childbirth, large babies may be at an increased risk for brachial plexus injuries. Babies in breech position bottom end comes out first and those whose labor lasts an unusually long time may also suffer brachial plexus injuries. Shoulder dystocia occurs when the shoulder is temporarily stuck under the pubis during delivery, and can result in brachial plexus injury. The severity of these injuries can vary widely. Some children with brachial plexus birth injuries recover spontaneously, and most children will regain all or most of their normal function through physical and occupational therapy.
A smaller group will require surgical intervention to achieve good function. Early diagnosis and treatment can improve long-term results. Symptoms depend on where along the length of the brachial plexus the injuries occur and how severe they are. Injuries to nerves that root higher up on the spinal cord, in the neck, affect the shoulder. If nerves that originate lower in the brachial plexus are injured, the arm, wrist and hand are affected.
Brachial plexus injury pain can be mild to severe, and temporary to chronic, depending on the type and extent of the injury. For instance, a simple stretched nerve may hurt for a week or so, but a ruptured nerve can cause serious, long-term pain that might require physical therapy and potentially surgery.
A health care provider will examine the hand and arm and test for sensation and function to help diagnose a brachial plexus injury. These tests may be repeated every few weeks or months to allow your doctor to monitor your progress. Some people, particularly babies with a brachial plexus birth injury or adults with neuropraxia, recover without any treatment, though it can take as long as several weeks or months for the injury to heal. Certain exercises can help with healing and function, but more severe injuries may require surgery.
Prompt examination by a health care provider is essential after any suspected brachial plexus injury. Mild brachial plexus injuries respond well to a combination of nonsurgical treatment options. Your doctor may recommend one or all of the following:. Brachial plexus injuries that fail to heal on their own may require surgery to repair the damage.
Nerve tissue grows and heals slowly, so it can take months to years to see the results of brachial plexus surgery. Brachial plexus surgeries should take place within six months of injury for the best chance at recovery. Procedures your surgeon might recommend include:. Our experts at the Johns Hopkins Peripheral Nerve Surgery Center are well-versed in all types of brachial plexus injuries, from birth injuries to radiation treatment complications. We use a holistic approach, creating an individualized treatment plan for each patient.
In infants, if no improvement is seen after three months of occupational therapy, consulting a pediatric neurologist and pediatric neurosurgeon can help determine if your child can benefit from other interventions or surgery. Up to 1 in 10 babies with brachial plexus injury will require some level of surgery. Prompt intervention is important. If the injury occurred during birth, the best time for surgery is when your child is between 4 and 9 months, as waiting longer than a year can limit the level of function a surgery might restore.
Because nerves heal slowly, brachial plexus injury recovery can take several weeks to months, depending on the severity. During this time, regular physical therapy appointments to prevent muscle atrophy and contractures are often necessary.
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