Brachial Plexus Injuries

The Brachial Plexus Clinic of the Dartmouth-Hitchcock Medical Center and the Children's Hospital at Dartmouth-Hitchcock offers multidisciplinary services aimed at treating brachial plexus disorders. As one of few centers in the country with expertise in brachial plexus disorders, our goal is to provide comprehensive surgical and medical treatment in a multidisciplinary setting.

Our team includes specialists in neurosurgery, micro/hand surgery, plastic and reconstructive surgery, neurology, and physical therapy. All of our team members meet with each patient during the appointment, maximizing the efficiency of the clinic and facilitating collaboration among the different specialists.

We offer treatment of infants with birth-related brachial plexus injuries, and older children with traumatic brachial plexus injuries, tumors, and other disorders of the brachial plexus.

Anatomy

The brachial plexus is composed of five large nerves that carry information back and forth from the brain and spinal cord to the shoulder, arm, and hand. Damage to these nerves can cause loss of sensation or weakness in the shoulder, arm, or hand depending on what nerve is injured.

Brachial plexus injuries in infants

Brachial plexus injuries in infants are typically a result of traction on the nerves going to the arm during birth. It is one of the most common injuries during the birthing process. The injury may involve one or more of the nerves that go to the shoulder, arm, or hand. The injury may be a mild stretch injury from which most children will make a very good recovery to more severe injuries from which children are much less likely to recover. Infants with brachial plexus injuries should begin physical therapy shortly after birth.

At one month of age, the patient is seen for an initial evaluation by our multidisciplinary team. At three months of age, the patient is seen again and evaluated for any signs of improvement. In most cases, children that show significant improvement at 3 months of age will not require surgery. In children that have shown no signs of improvement by three to six months of age, special testing including electromyography (EMG), magnetic resonance imaging (MRI), or computed tomography (CT) myelogram may be done to guide management.

If surgery is recommended, it is typically performed between four and nine months of age. The operation is done under general anesthesia and takes between five and 10 hours. Children typically spend one to two nights in the hospital after the surgery. The child's arm may be supported by a special sling, which the child will wear for one to three months after the surgery to allow the nerves to heal. Physical therapy typically begins about two weeks after surgery and lasts for up to three years after surgery. Signs of recovery typically occur anywhere from four to six months after surgery and may continue up until 3 years after surgery.

Brachial plexus injuries in older children

Brachial plexus injuries in older children are most commonly due to trauma caused by automobile, motorcycle, or bicycle accidents. In the case of an older child with a brachial plexus injury, we prefer to evaluate the patient shortly after injury at which time a detailed motor and sensory examination of the arm is performed. Depending on the type and nature of the injury, surgery may be offered at that time or more typically, after a three-to-six month period of recovery. At that time, additional testing including EMG, MRI, and/or CT myelogram may be performed to guide management.

If surgery is recommended, it is typically done between three and six months after injury. The operation typically takes between five and 10 hours. Most patients spend one or two nights in the hospital after surgery. Depending on the type of operation, a sling or splint may be used to limit arm motion for the first several weeks after the surgery. Physical therapy is started two weeks post-operatively and continues for two to three years after the surgery.


Page reviewed on: Nov 19, 2009

Page reviewed by: Susan R. Durham, MD, MS

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