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The network of nerves that originate in the spinal cord and control the muscle movements of the forearms, hands, and shoulders is called the brachial plexus. If every nerve in this group is okay the person’s hand movements are good. But if an injury or trauma happens, then he may lose sensation, be paralyzed in the arm, or it may cause pain or have weak muscle movements or have tingling sensations. Apart from accidents, falls or such traumatic occurrences, and tumors, the most common cause of brachial plexus injury happens during birth (Erb’s palsy). One child in two thousand may suffer from it and only ten percent of such cases need medical aid; the rest gets cured on their own. It may be due to difficult birth or some trauma, which causes this injury. Sometimes only the nerve gets pulled or stretched. This is called neuraprexia or stretch and is the most common form of brachial plexus injury. Fortunately, most such cases heal on their own and some heal completely within three to four months. If they don’t then medical help is necessary. Other injuries may be more serious resulting in the necessity of surgical intervention.
The symptoms are easily noticeable and action should be taken as soon as possible. If nature does not do her work, then man has to step in. After adequate physical tests, study of medical records, testing using an electromyogram (EMG or electromyography) or myelogram where a dye is inserted to check on the damage of the nerves, the surgeon will decide the course of action. Each case is different and each has to be treated accordingly. Sometimes one person falls, hurts himself and nothing more than pain or bleeding occurs. In another similar fall, another child may not only have pain and bleeding but even his nerves may be affected resulting in brachial plexus injury.
The most serious form of injury is nerve root avulsion which causes complete weakness in muscles. This may be due to high velocity impacts like in motorbike accidents. Sometimes physiotherapy may work wonders. Or light massage with some oil or cream may cure the condition. If these methods fail then surgery has to be attempted. Some patients may need constant monitoring, others may need lifelong medicines. Treatment depends on the severity of the injury.
Nerve grafts, nerve transfers, muscle transfers and the like may be necessary for serious conditions. Surgeons can repair the damaged nerves of the brachial plexus to restore some function to the arm by using advanced microsurgical techniques. Neurolysis clears scar tissue from the nerves. Nerve graft is a transplant from a leg nerve and nerve transfer is the sewing of an adjacent functioning nerve or past of the nerve into the non-functioning nerve to restore function to the paralyzed muscle. This should be done before the child is a year old.
If the primary surgery does not work or is not fully successful a secondary surgery may be needed and this should be done as soon as possible preferably by the time the child is two years old.
Mayo Hospital in Minnesota is one of the largest centers in the United States which treat Erb’s palsy and brachial plexus injuries performing hundreds of delicate and highly specialized surgeries every year. |
