A brachial plexus injury (BPI) occurs when any area of the network of brachial plexus nerves are damaged. For infants, these types of injuries occur most often during a strenuous, difficult labor and delivery. The seriousness of BPIwill depend on how severe the injury is and where the damage happens. While some cases of BPI will bring about devastating consequences, other less severe injuries can clear with little or no treatment within months.
Treatment for Minor Brachial Plexus Injuries
Although recovery after a brachial plexus injury can be unpredictable, most babies who experience minor trauma, such as the nerves stretching or pulling, will go on to heal by themselves. Physicians may conduct examinations and X-rays over a span of a few months after the injury to ensure it’s healing properly.
In many cases, physical therapy is recommended to help speed up the recovery process, but it’s important for infants to start as soon as possible for the best chances. A physician will usually create and guide a physical therapy plan and help ensure that parents understand what’s needed for home care as well as clinical sessions. Plans may vary according to each individual case, and may consist of:
- Range of motion exercises
- Sensory awareness
- Flexibility activities
- Myofascial release exercises
- Home activities such as exercising the infant’s functioning muscles and joints
Fortunately, the majority of infant BPIs are not too severe. Usually within three to six months, as previously mentioned, the damage will heal and the baby will have full use of the arm, wrist, and hand of the affected area.
Treatment for Severe Brachial Plexus Injuries
The more serious and severe cases of brachial plexus injuries may require surgery, typically if the affected area hasn’t improved within three to six months after the injury. Although it’s been met with mixed outcomes, nerve grafting and nerve repair is the most common form of surgery.
The procedure is carried out by taking a healthy nerve from another part of the body. The healthy nerve is then transferred to the damaged brachial plexus nerve. For example, an undamaged nerve in the leg or in between the rib bones can be taken out, transferred to the damaged nerve area, and then grafted into place. The success of nerve transfer and grafting greatly depends upon how serious the injury is. Those with less-severe injuries who still require surgery have a much better chance of full recovery when compared with those who have severe nerve damage.
According to Dr. Scott W. Wolfe of the Hospital of Special Surgery (HSS), if nerve grafting is successful, the patient should have function of the affected area within several months.
“What is amazing is the degree of redundancy within the peripheral nervous system that allows us to detach a portion of a functioning nerve without causing a loss of strength or sensation, but then re-attach the same nerve elsewhere and regain lost muscle function in a matter of months,” Dr. Wolfe said.
Neuromuscular Electrical Stimulation
Neuromuscular electrical stimulation (NMES) is a popular form of treatment for and children, but is usually reserved for ages three and over. NMES includes applying currents to the muscles in the damaged area via alternating currents, leading to increased blood flow and muscle function.
Neurolysis is a procedure in which chemicals are applied to the affected area for pain relief and to freeze or burn off injuries that are affecting the nerves. For brachial plexus injuries, neurolysis is generally used for neuroma, a type of brachial plexus that occurs when scar tissues form over the damaged nerve. This is turn causes added pressure and pain to the damaged area.
Neurolysis may involve a combination of hot and cold applications, and in some instances, chemical agents such as alcohol, glycerol, or phenol.