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Brachial Plexus Injuries
Brachial Plexus injuries in infants and children are not uncommon. Approximately 1 to 3 in 1000 children have an injury to their Brachial Plexus during birth. An infant with a Brachial Plexus injury will have a weak arm, the baby may be unable to raise the arm, or may have difficulty moving fingers. Large babies, who are born as a result of a difficult delivery, are more likely to have these problems. Associated fractures of bones, such as the clavicle, can also occur.
Many infants recover complete or near complete function with occupational therapy. If the infant remains weak, however, after about 4 months of therapy he or she should be seen by a doctor who specializes in the care of the Brachial Plexus.
The Brachial Plexus is a web of nerves which come from the cervical spine merged together at the base of the neck and extend out through the shoulder into the arm. These nerves are responsible for muscle function of the arm including the ability to raise the arm above the head, bring the hand to the mouth, and move the fingers. In addition, these nerves also provide information to the brain about sensation in the skin and position of the arm.
Infants who fail to improve with therapy alone may be candidates for surgical intervention. A multi-disciplinary team which usually includes a physical medicine and rehabilitation physician, a pediatric neurologist, a pediatric neurosurgeon, a plastic surgeon, and orthopedic surgeon who will evaluate the suitability of the child for surgery or other interventions. In general, children who show continued weakness after 6 months of age may benefit from surgery.
For many years it was thought that little beyond therapy could be done to help the infant with Brachial Plexus injury. Recently it has become clear that surgical intervention, which may include removal of nerve scar tissue, grafting of nerves to create new pathways for the signals from the brain, and movement of muscles and tendons will be beneficial to infants. The best results are achieved when infants have their first surgery before their first birthday.
Parents and physicians who have questions regarding the care of the infant with Brachial Plexus are encouraged to contact the Pediatric Neurosurgery office at (706) 721-5568.