Pediatric Brachial Plexus Program

Specialized Care for Nerve Injuries

Brachial Plexus ClinicPediatric brachial plexus injuries are not common but can have a profound impact on how a child’s arm functions. The brachial plexus is a group of nerves located at the base of the neck that carry signals from the spinal cord to the arms, hands and back. Injuries to these nerves can occur in different ways, ranging from difficult delivery at birth to sports injuries and major traumas.

The result can be varying degrees of upper extremity and hand paralysis, loss of sensation or both, which can be permanent if left untreated. Prompt evaluation and appropriate treatment of injuries to the brachial plexus are important to complete recovery.

Children’s Healthcare of Atlanta has a multidisciplinary team that provides a knowledgeable approach and specialized care for brachial plexus injuries. Our team includes:

We also encouraged parents and caregivers to take an active role in their child’s care. We work with parents and the child to develop the best plan of care.

Print-friendly PDF about brachial plexus birth palsy.

Twice a month, we also provide a brachial plexus clinic at the Judson L. Hawk, Jr. Center for Children, located at Children’s at Scottish Rite. Our staff will work with your family so that most of your child’s care can be done at home.

What to expect on your first visit 

Orthotics and Prosthetics Program 

 

Frequently asked questions

  • What is the brachial plexus?
      The brachial plexus is a group of nerves located at the base of the neck that give motor function and sensation to the shoulder, arm, wrist, hand and fingers. These nerves are formed directly from the nerve roots that exit the spinal cord.
  • What causes a brachial plexus injury?

      Injuries to the brachial plexus most commonly occur as a result stretching the nerves too far, like when the head and neck are forced away from the shoulder.

      Brachial plexus birth palsy can occur during childbirth and sometimes result in temporary paralysis of an arm. The incidence rate of brachial plexus injuries at birth is approximately three per 1,000 births. Risk factors for brachial plexus birth palsies include shoulder dystocia, maternal diabetes, large gestational size, difficult deliveries and a previous history of children born with a brachial plexus injury.

      Later in childhood, brachial plexus injuries can occur in several ways, like automobile accidents or while playing sports. Direct injury to the nerves due to a penetrating wound is less frequent.

  • Is the injury permanent?
      It is difficult to tell if a brachial plexus injury will result in permanent impairment early on. The severity of the injury to the nerves will likely determine the treatment and any expectations of recovery. While injuries do tend to follow certain patterns, each case must be considered individually.
  • Will my child be in pain after the injury?
      Discomfort following a brachial plexus injury can occur. Older patients describe the discomfort as the feeling of “burning” or “pins and needles.” However, newborn babies and infants should not require pain medication following a brachial plexus injury.
  • Does my child need therapy?

      Physical and occupational therapy are important elements of the treatment for a patient with a brachial plexus injury. In the initial stages of recovery, therapy to maintain joint motion is recommended. In all patients who sustain a neurologic injury, therapy to preserve and improve range of motion and strength is vital to maximizing upper-extremity function.

      Families are encouraged to participate in the process by performing therapy tasks at home. We will educate families about which exercises to do and how to perform them.

  • Does my child need an MRI?

      Whether or not your child needs magnetic resonance imaging (MRI) will likely depend on his age. Since MRIs do not usually change the treatment plan for infants, it is not our standard practice to order MRIs for the evaluation of a child with brachial plexus birth palsy. In some cases, MRIs are ordered to assess the shape of the developing shoulder joint and guide treatment aimed at maintaining and optimizing shoulder function.

      Older children with traumatic brachial plexus injuries frequently have MRI evaluations performed at the medical centers where they are initially evaluated. In these cases, the extent of the injury can be more clearly defined, possibly altering the plan for surgical or nonsurgical care.

  • Does my child need an EMG or nerve study?
      These studies may be recommended for older children with a traumatic brachial plexus injury but are not typically used on infants. In the setting of brachial plexus birth palsy, electromyography (EMG) evaluations often overestimate the prognosis for recovery and can complicate treatment decisions. The test can also be rather uncomfortable, so we do not routinely order EMGs or nerve studies for infants. Studies show that physical examination offers the most accurate picture of whether an infant with a birth-related brachial plexus injury will require early nerve reconstruction.
  • Does my child need surgery?

      Surgery may be suggested initially depending on the child’s age, time since injury and functional status but is only offered when well-established criteria are met. Your doctor will work with you to determine if surgery is the best treatment for your child. The types of surgeries that may be used include:

      Nerve grafting/repair – This surgery repairs the brachial plexus nerve if possible or removes the damaged portion of one or more of the nerves and replaces it with an uninjured nerve.

      Nerve transfers – This surgery involves connecting a functioning nerve with a different purpose to a nerve that is not working in order to stimulate a muscle that is not functioning well.

      Free muscle transfers – This surgery involves transplanting an entire muscle, along with its nerve and blood vessels, from one part of the body into the arm. The muscle, usually an unimportant leg muscle, is re-animated by a living nerve and revived by local blood vessels.

      Tendon transfers – This surgery involves the reassignment of muscle-tendon units to new functions to assist where it may have been lost.

      Bone and joint surgery – Bone reconstruction and joint fusion surgeries are at times performed to treat the later consequences of nerve injuries. These are used to reposition joints to a better position with the goal of enhancing function.

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