treatment of birth injuries
Brachial plexus injuries occur in approximately 1 in 2,000 births, but only about 10 percent of these babies need treatment; most heal on their own. Early evaluation (within the first one to two months of life) is important to determine whether therapy or surgery is required.
Treatment Options
Treatment depends on the type and severity of the injury:
- Avulsion — the nerve is torn from the spine
- Rupture — the nerve is torn, but not where it attaches to the spine
- Stretch — the nerve has tried to heal itself (forming a neuroma), but scar tissue has grown around the injury, limiting nerve function
Independent Recovery
Infants with milder injuries often heal on their own, but exercise and therapy are prescribed to ensure full recovery. Regular follow-up appointments track an infant's progress and ensure that the treatment plan is on the right track.
Primary Surgery
Infants with mild injuries who do not heal by 3 to 4 months of age, or those with more severe injuries (such as avulsions or ruptures), need surgery to improve or correct nerve function. This surgery is best performed by a highly skilled, experienced team and ideally should occur within three to six months after birth. After children turn 1 year old, nerve surgery may not be as successful.
surgeons are highly skilled in microsurgical techniques to make delicate repairs in the nerves, using one or more methods, including:
- Neurolysis — clearing scar tissue from the nerve
- Nerve graft — a nerve is transplanted from the infant's leg to reconnect the damaged nerve(s)
- Nerve transfer — sewing an adjacent, functioning nerve or part of a nerve into a nonfunctioning nerve in an attempt to restore function in a paralyzed muscle
Secondary Surgery
When there is less than full recovery, other conditions sometimes develop involving neighboring joints of the arm. These conditions can result in muscle imbalance or shortening of the muscle (contractures). In these cases, other procedures can be performed when the child is older, typically between ages 2 and 10. Possible procedures include:
- Free muscle transfer
- Capsule release
- Tendon transfer
- Correction of the arm (osteotomy)
- Joint fusion
After Surgery
In many cases surgery restores useful shoulder, elbow and hand function. Rehabilitation specialists and pediatricians assist in the postsurgical care, including prescription of physical therapy exercises and other recommended treatments to help the child function as normally as possible