A Brachial plexus is a network of spinal nerves that start in the back of the neck, and go on to the armpits and the upper limb. Any injury to any part of the brachial plexus affects the nerves supplying the shoulder, upper arm, forearm and hand and causes numbness, or tingling or pain and weakness, lack of muscle control and may cause limited movement or even paralysis of the upper limb.
Though injury to the brachial plexus may happen any time, due to some accident or injury, most of them happen during birth. Delivery trauma may impact the baby’s shoulders causing the brachial plexus nerves to stretch or tear. About one in two thousand births result in brachial plexus injury also called the Erb’s palsy or obstetrical plexus. Most heal on their own and only about ten percent need surgical intervention. Most of these birth related injuries to the brachial plexus are divided into four types: avulsion which is a very severe type in which the nerve is torn from the spine; rupture where the nerve is torn but not from the spine; neuroma where the nerve has tried to heal itself but scar tissue around the injury has put pressure on the injured nerve and prevented the nerve from communicating with the muscles and neurapraxia or stretching of the nerve which has been damaged but not torn. This last is the most common type of brachial plexus injury. The brachial plexus injury and its result, is apparent soon after birth or accident. Sometimes other important issues and injuries may overshadow the diagnosis but once the treatment begins there is hope. Treatment depends on the type of the injury. Most birth related injuries of brachial plexus may heal on its own without any external intervention. Some may take three or four months. Other types of injuries may need occupational or physical therapy and some may need surgery to improve the condition.
Using advance microsurgical techniques, surgeons can repair the damage and restore some function to the body part. These may include nerve and muscle transfers as well. Though the majority of the cases can become normal to a great extent, a few may need lifelong care and treatment. Each case is different, needs different diagnosis and treatment and care. The options are neurolysis, nerve grafts, nerve transfers, muscle transfers and others. The recovery will be closely monitored.
Mayo’s clinic in Minnesota in the US is one of the largest centers for treatment of Erb’s palsy and brachial plexus injuries. They perform hundreds of highly specialized and delicate surgeries round the year. |
