Brachial Plexus Program

What is the Brachial Plexus?

The brachial plexus is a system of nerves located between the neck and arm. All nerves begin at the spinal cord. The spinal cord is divided into sections. The upper sections of the spinal cord are the cervical and thoracic areas and are abbreviated by “C” and “T”. The plexus consists of nerves that run from sections C5-T1 of the spinal cord and continue into the arm. Specific sections of the brachial plexus control different groups of muscles and motions in the arm. For example, Erb’s palsy is a brachial plexus injury involving the nerves from C5-C6 which affect shoulder movements, elbow bending, and forearm supination (turning the palm up).

How Does a Plexus Injury Occur?

Brachial plexus injuries most often occur during birth. Once the baby’s head is delivered, the doctor may need to turn the head in order to deliver the shoulders. The injury occurs when there is an increased angle between the head and shoulders. This places an increased amount of stretch and tension on the nerves.

Types of Plexus Injuries

There are three types of brachial plexus injuries: stretch, rupture, and avulsion. A stretch injury occurs when the nerves have been stretched, but not torn. Rupture and avulsion injuries are more serious than stretch injuries and may require surgery. In a rupture injury, the nerves have been torn, but not at the spine. In an avulsion injury, the nerves have torn from the spine. With a rupture or avulsion injury, a neuroma may be present. A neuroma is scar tissue that builds-up where a nerve has torn. In order for the nerve to heal, the neuroma must be surgically removed.

How Can Shriners Hospitals for Children® Help?

The doctors and therapists at our hospital see hundreds of children with brachial plexus injuries each year. Every injury is different and the responses to treatments vary as well. Through periodic clinic appointments, doctors and therapists will monitor changes in your child’s range of motion, ability to complete functional activities and ability to use the injured arm. Occupational therapy sessions can be arranged to teach range of motion and stretching exercises to encourage movement and use of your child’s arm in daily activities. For some children, surgery may be an appropriate option. There are many surgical procedures available to improve functioning of the arm after a brachial plexus injury. The overall goal of any surgical procedure is to increase motion, function, and spontaneous use of the arm in daily activities. Surgery is not always the primary method of treatment. Many children may regain motion in their affected arms through conservative treatment methods.

How Can I Help My Child?

It is important to remember that your child will not regain movement overnight. Doctor’s visits and therapy appointments will help to monitor gradual changes in your child and have his or her progress recorded. At these visits, the need for surgical and therapy intervention will be discussed. When at home and throughout your child’s day, he or she should be encouraged to use the affected arm as much as possible. Encouragement can occur through positioning, stretches and activities. Examples of these should be prescribed by your child’s therapist.

Treatment

Conservative treatment will help the affected arm maintain as much motion as possible. When a person does not use his or her arm, the joints in the arm may become stiff and difficult to move. Through a variety of treatment, your child’s therapist will encourage movement to prevent joint stiffness and promote function. Conservative treatment methods include:

Splinting – Splints can be made specifically for your child. They are typically made of hard plastic and will hold a joint on the affected arm in a specific position. Depending on the joint the splint will be used for, the splint may be used to stretch the joint or to place the joint in a functional position for a variety of activities.

Stretching exercises – Stretching exercises are used to encourage movement in the joints of the injured arm. Stretching exercises will help to prevent stiffness while maintaining any motion currently present in the joint

Home therapy programs – Your child’s therapist may prescribe a program of activities and stretches to complete at home as well as specific instructions about splint use if your child has received a splint. It is important to follow all instructions given by your therapist regarding how often to complete the home therapy program. Most home therapy programs aim to promote and maintain joint motion and encourage functional use of the affected arm.