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:
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 video below.
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 orthopedic 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 orthopedic surgeons restore strength, range of motion, and balance in the arm with surgical procedures, including:
- Tendon transfers
- Tendon lengthening
- Bone lengthening, shortening and repositioning
- Shoulder joint relocations
One orthopedic 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.