What is brachial plexus and peripheral nerve injury?

Brachial plexus and peripheral nerve injuries refer to injuries to the group of nerves that supply the arms and hands. These injuries include birth-related palsies, trauma and peripheral tumors.

The brachial plexus is a network of nerves that run from the cervical spinal cord in the neck to the shoulder, arm and hand. These nerves are responsible for stimulating the muscles of the upper extremity as well as signaling sensation or feeling of the arm. An injury to one or more of these nerves can result in varying degrees of upper extremity weakness or paralysis and numbness.

Types of injury include pulling, stretching, tearing, or compression of the nerve(s). Some nerve injury is temporary, and patients recover most, if not all, function on their own with occupational therapy and time. However, some nerve damage is more severe, and patients with these conditions benefit from surgery and occupational therapy.

Treatment for brachial plexus and peripheral nerve injuries

Occupational therapy

Many patients with birth-related brachial plexus injuries recover enough motion and strength and do not need early surgery. For all patients, we encourage regular sessions with occupational therapy, whether it is at Children’s Hospital of Philadelphia (CHOP) or locally if patients live outside the Philadelphia region.

Goals for therapy focus on:

• Promoting nerve recovery
• Preventing joint contractures
• Maintaining range of motion in the upper extremities and neck
• Facilitating optimal use and typical movement patterns

Typical therapy interventions include:

• Range of motion exercises and stretching
• Splinting
• Joint compression and weight bearing to facilitate muscle contraction
• Bilateral motor planning activities
• Facilitating optimal alignment in the shoulder and scapula to promote smooth movement in all directions
• Aquatic therapy when indicated

In addition to these regular sessions, your child’s occupational therapist will also teach you exercises that should be performed every day with your child to keep the joints supple and encourage normal motor development.

Patients are closely followed by our team for signs of functional recovery of the upper extremity. If there are no signs of recovery or not enough muscle recovery, then patients may get additional testing and evaluations to discuss surgical options to improve function.

Surgical intervention

Early surgical intervention for brachial plexus and other nerve damage is usually decided between three to six months after injury. We carefully follow each patient for signs of recovery and personalize treatment based on the type and degree of injury.

Early surgical treatments include:

• Surgical exploration
• Neurolysis — releasing nerve from scar tissue
• Nerve grafting — taking nerve from elsewhere on the body to bridge a nerve gap after cutting away damaged nerve
• Nerve transfers — using working nerves to stimulate nerves and muscles that are not functioning well

Secondary procedures may be needed as children grow and are designed to augment their function. These surgeries include:

• Tendon or muscle transfers — using working tendons or muscles to power weak or non-working muscles
• Release of tight muscles or joints
• Osteotomies — cutting and repositioning the bones
• Joint fusions