Brachial Plexus Palsy and Sequelae Surgery

The Brachial Plexus refers to the network of nerves responsible for conveying signals from the upper spinal cord of the neck region to the shoulders, arms, and hands. Trauma or injury to the neck or shoulder can potentially injure the Brachial Plexus when the nerves may become stretched, compressed, or, in serious conditions, even ripped or torn. In such cases, there can be incidents of pain, weakness, numbness, and even paralysis in severe cases.

Injuries to the Brachial Plexus nerves may heal on their own, but severe complications such as Brachial Plexus Palsy may require surgical intervention to restore mobility, function and sensation as well as to relieve painful symptoms.

Causes of Brachial Plexus Palsy

Brachial Plexus injury in newborns can occur as a result of difficulty during childbirth, such as in the case of a big baby or during prolonged labour. Brachial Plexus injury as a result of stretching may also occur in case of an emergency delivery where the baby is pulled forcefully from the birth canal.

Symptoms of Brachial Plexus Palsy

The nerves that make up the Brachial Plexus carry information in the form of electrical signals from the brain through the spinal cord to the shoulders and hands, covering the arms and wrists. Nerves damaged along this pathway can cause the loss of electrical signals that do not reach the muscles of the shoulders and/or arms. As a result of this, there can be certain visible symptoms in such infants, which may include the following:

• Improper mobility of the affected arm
• Muscles in the affected arm start getting smaller (muscle wasting)
• Limited perception of sensation in the affected limb

There can also be other impacts in infants with Brachial Plexus Palsy, which may include:

• A broken collar bone (clavicle)
• A broken bone which is present in the upper arm (humerus)
• Horner’s syndrome, in which the eyelids droop and the pupil of the eye becomes slightly smaller on the side of the affected limb

Diagnosis of Brachial Plexus Palsy

A paediatrician may be able to diagnose the occurrence of Brachial Plexus Palsy in an infant based on the visible symptoms in the arms, along with a physical examination. To confirm the diagnosis, the paediatric doctor may order certain imaging tests, including MRI scans, X-rays, and ultrasound scans. These imaging tests may provide additional information about the extent and location of damage along the neck, shoulder and arms.

The doctor may also recommend additional tests to learn whether there are any nerve signals present in the muscles of the affected upper arm. These tests might include an Electromyogram (EMG) or a Nerve Conduction Study (NCS). Once an assessment has been done, the treating paediatrician may collaborate with occupational therapists, physical therapy specialists, and other medical professionals to prepare a customised treatment plan taking into account the needs of the infant and the severity of the condition.

Treatment for Brachial Plexus Palsy

In most cases, infants and children may not require any formal treatment as they may recover from Brachial Plexus Palsy on their own. The treating doctor may examine the child frequently to check the progress of natural recovery as they would be in the process of continuous growth, which entails that their nerves grow constantly. But this is a slow process, often requiring almost two years to make a complete recovery. However, specialised physical and occupational therapy specialists may be involved in the process of recovery who may assess the baby’s arms over a period of time and look for signs of improvement in function, shape, size, and movement of the arms.

Taking Care at Home

Paediatricians and therapists may recommend daily physical therapy exercises and range-of-motion exercises to obtain the best possible result and aid in faster healing. Physiotherapists and occupational therapists may assist the parents in learning and understanding how to incorporate these exercises into the baby’s daily routine and take an active role in keeping their joints and muscles fit and functional.

The therapy exercises may begin as early as three weeks after birth or as soon as diagnosed in an infant. The goal of these exercises is to maintain the range of motion of the shoulders, arms, elbows, and wrists to prevent stiffness and restore neural function.

Who May Need Brachial Plexus Surgery?

Although most babies do not require surgical intervention for the treatment of Brachial Plexus Palsy, there may be rare cases of no change or improvement of the condition over the next 3 to 6 months of non-surgical treatment. Based on the continual assessment of the condition by the treating paediatric doctor, surgery on the nerves, muscles, and bones may be recommended to improve the potential outcome.

Types of Surgical Treatment for Brachial Plexus Palsy

There are a few surgical treatments available for Brachial Plexus Palsy, out of which microsurgery may be considered as the first line of surgical Brachial Plexus Palsy treatment.

Microsurgery

Paediatric surgeons make use of high-powered microscopes and small-sized specialised instruments for surgical treatment of nerves. Depending on the nerve injury, two types of surgical treatment options are available:

• Nerve graft: A ruptured nerve may be repaired by splicing a donor nerve graft.
• Nerve transfer: To restore function in an arm, a nerve can be surgically transferred and used from another muscle of a donor.

Since the rate of recovery of nerves is very slow, it may take several months to even years to have complete recovery of the nerves in the neck. Post-surgical rehabilitation exercises may be recommended by paediatricians to be performed at home to improve the baby’s strength in the arms as well as to improve range of motion.

Other Procedures

Other surgical procedures are also available for the treatment of Brachial Plexus Palsy, which may include the following:

• Release of Joint Contractures: If soft tissues around the shoulder and elbow joints become thickened, surgical treatment may help to allow more range of motion.
• Tendon Transfer: In a tendon transfer procedure, a functioning tendon is transferred from a normal attachment to the shoulder area to enable greater mobility of the arms.

Outcome & Recovery

It may be likely for children undergoing treatment for Brachial Plexus Palsy to continue to experience some amount of weakness in the affected limb and shoulder. Surgical intervention for improvements in function may be performed later on as deemed fit by the concerned orthopaedic doctor.

Apollo Hospitals, Karnataka, is one of the most trustworthy and reliable names among patients in the area of surgical treatment of a myriad of health conditions, tending to emergency and planned surgical cases. We strive to deliver world-class healthcare services with support from our team of speciality medicine doctors and surgeons who aim to provide medical care, keeping in mind the individual needs and comfort of our patients. The use of technologically advanced and innovative surgical equipment enables us to provide exceptional medical treatment with minimal intervention while ensuring quicker recovery and recuperation.