Lurie Children’s offers the state’s most comprehensive and coordinated multidisciplinary program for infants and children with brachial plexus palsy. The brachial plexus is the network of nerves that begins in the spine and goes through the neck, running through the shoulder, and down the arm to the hand. Palsy means weakness. Erb’s Palsy is a form of brachial plexus palsy in infants.
Our brachial plexus specialists evaluate and treat children from birth through adolescence. These injuries can impair the nerves that send movement signals to the joints, muscles, ligaments and tendons in the shoulder, arm and hand. We treat these injuries as early as possible because they can lead to arm weakness, paralysis and lack of feeling (resulting in a loss of function).
Most brachial plexus injuries occur in the neonatal period, resulting from trauma before and at birth. Newborns are referred to us immediately after birth for evaluation and treatment from hospitals throughout the Midwest. We also treat children and teenagers with brachial plexus injuries resulting from motor vehicle and sports-related accidents. In a very small number of cases, this condition results from a tumor.
The goal of the Brachial Plexus Palsy Program is to make our patients' shoulders, arms and hands as functional as possible. We want your child to participate in normal childhood and adolescent activities — our treatments can make that a reality.
The Lurie Children's Difference
Parents play a central role in the decision-making process for their child’s care at Lurie Children's. Parents are involved in therapy sessions, which help maximize their child’s abilities and progress. Therapy can be long term, but it doesn’t just happen in our offices. We teach and encourage families to integrate therapy exercises into activities of daily life.
We teach parents how to:
Encourage motor function for normal development
Incorporate exercises into everyday activities
Support and develop symmetrical posture and alignment throughout the body
Use age-appropriate toys around the home
Involve their children in sports and games
Give their children sensory experiences to improve motor function
Our treatments and therapies encourage children to participate in karate, swimming, dancing and other age-appropriate activities, as they help maintain function through adolescence and early adult years.
What to Expect
Your child will have an initial, comprehensive evaluation from our multispecialty brachial plexus team, which may take about two hours. Our team includes the following specialists:
Orthotists (brace-fitters and bracing specialists)
Orthopaedic and neurosurgery nurses
As parents and family members, you will be involved in every step. Our specialists will discuss your child’s condition with you and discuss all therapies with you. We will present treatment options tailored to your child’s needs. Some early tests to help with the evaluation may include an x-ray, an EMG, a CT scan or an MRI. If needed, these are generally done after the first visit.
Our occupational therapists will begin therapy, including range of motion and activities to develop awareness of the involved side, and promote alignment of the head, trunk and arm. They will talk with you and show you how to properly position and protect your child’s arm during dressing, feeding and carrying/moving. Our therapists use a variety of therapy aids to encourage healthy movements and feeling in the affected arm, including soft splints and tapes.
To see sample therapy sessions for children with brachial plexus palsy, watch the videos below.
A brachial plexus occupational therapy session with an infant.
A brachial plexus occupational therapy session with a 2-year-old.
A brachial plexus occupational therapy session for a 2-year-old with a sensory processing disorder.
Our specialists often use non-surgical treatments and therapies to stimulate, stretch and strengthen your child’s affected arm. These can rebalance overactive muscles and allow weak muscles to become more active. We also use electrical stimulation, which is not painful, and can help to increase sensory awareness of the muscles and build up weak muscles. Finally, our bracing specialists may design custom splints and braces. These can help with stretching, repositioning the limbs and holding the arm or hand in correct alignment.
The vast majority of children with birth-related brachial plexus injuries recover without surgery. If your child does not recover well by age 3 or 4 months, our specialists will consider surgery in the first year of life. The goal of surgery is returning function and feeling to your child’s arm. Surgery can include both neurosurgery, involving the nerves, and orthopaedic surgery, involving bones, joints, muscles, ligaments and tendons.
Our neurosurgeons restore feeling and movement by repairing damaged nerves. They reestablish nerve pathways that allow your child’s brain to send movement messages to the arm, using these surgical procedures:
Neurolysis - Removes unhealthy tissues that press on the nerves and keep them from sending movement signals to muscles
Nerve bypass - Adds a piece of healthy nerve, like a bridge, and reestablishes the nerve pathway
Neurotization - Helps to grow new nerve tissue
Our orthopaedic surgeons restore strength, range of motion, and balance in the arm with surgical procedures, including:
Bone lengthening, shortening and repositioning
Shoulder joint relocations
One orthopaedic operation that is commonly performed on children with left over weakness from Erb’s palsy includes five components: transfer of the latissimus dorsi tendon, transfer of the teres major tendon, relocation of the shoulder joint, partial weakening of the pectoralis major tendon, and partial weakening of the subscapularis muscle.
Following surgery and early therapies, most children who have had a brachial plexus injury continue to need therapy on an outpatient basis and at home. This can include occupational and physical therapy as well as sports training to maintain and improve muscle strength, balance and range of motion. Our team of specialists continues to work with these children for many years.
Shubhra Mukherjee, MD, is an attending physician in pediatric rehabilitation medicine at Lurie Children’s and Assistant Professor of Physical Medicine and Rehabilitation at Northwestern University Feinberg School of Medicine. As a co-director of our Brachial Plexus Program, she oversees the treatment of newborns and works closely with our team of specialists to identify the best care plan for each child. She meets with parents and families, provides education and walks them through the testing and treatment process.
Erik C. King, MD, is an attending physician in orthopaedic surgery at Lurie Children’s and Associate Professor of Orthopaedic Surgery at the Feinberg School. As a co-director of our Brachial Plexus Program, he evaluates and treats children with health issues associated with bones, joints, muscles, ligaments and tendons, including fractures and dislocations. The surgical procedures he performs for children with brachial plexus palsy include tendon transfers; tendon lengthening; bone shortening and lengthening; and joint relocations.
Tord D. Alden, MD, is an attending physician in neurosurgery and Assistant Professor of Pediatric Neurosurgery at the Feinberg School. As a co-director of our Brachial Plexus Program, he works closely with Dr. Mukherjee, Dr. King and Dr. DiPatri to assess nerve damage and develop a treatment plan that ensures maximum feeling, movement and comfort. Dr. Alden performs many of the important nerve surgeries.
Arthur DiPatri Jr., MD, is an attending physician in neurosurgery and Professor of Neurological Surgery at the Feinberg School. As co-director of the our Brachial Plexus Program, he works closely with Dr. Alden, Dr. King and Dr. Mukherjee to evaluate the needs of each child and develop a plan to bring damaged nerves back to full function. Along with Dr. Alden, Dr. DePatri performs many of the important nerve surgeries.
Janese Petuchowski, OTR/L, CHT, is a licensed occupational therapist, certified hand therapist, and Clinical Coordinator of Occupational Therapy. She is actively involved with children and families affected by brachial plexus injuries from the earliest days following referral, through evaluation and treatment. Janese works closely with Kristina Stein, OTR/L, who is a staff occupational therapist, also working toward her certification in hand therapy. Together they act as liaisons between the treating therapist, families and MD’s to coordinate therapeutic care and act as consultants to outside therapist needing clinical support.
Zaida Torres, RN, BSN, is a Nurse Clinician in the Division of Sports Medicine and Orthopaedic Surgery, and the first contact for most patients and families in the Brachial Plexus Palsy Program. She interacts with everyone and stays closely involved with our families, providing important education, guidance, and resources.