Brachial Plexus Center

The brachial plexus is a system of five nerve roots that exit from the spinal cord beginning with the C5 nerve root, which exits between the C4 and C5 vertebrae. The five nerve roots are known as C5, C6, C7, C8 and T1.

Nerve roots C5 and C6 make up the upper trunk (row) of the brachial plexus.

• They are the most frequently injured nerves (often called Erb’s palsy).
• These nerves tell the shoulder to move and elbow to bend.

Nerve root C7 makes up the middle trunk (row) of the brachial plexus.

• This nerve tells the wrist to move and elbow to straighten.

Nerve roots C8 and T1 make up the lower trunk (row) of the brachial plexus.

• These nerves tell the hand and fingers to move.

 Neonatal brachial plexus palsy occurs in 1.5 per 1,000 live births. Less than half of infants with brachial plexus palsy have known risk factors. Known risk factors for neonatal brachial plexus palsy include:

• Large birth weight
• Mother with diabetes
• Prolonged labor
• Instruments used during delivery
• Shoulder dystocia (dis-toe-sh-uh)
• Breech presentation
  

• Approximately two-thirds of children with brachial plexus palsy get better on their own with minimal treatment. Most children benefit from therapy. 
• Getting the right treatment for your child will maximize motor function, promote increased signals to the brain and minimize growth deformity. 
• We strongly recommend early evaluation and treatment for children with neonatal brachial plexus injury.

Non-Surgical Treatment: 

• Therapy: An important part of your child’s recovery. Family education and home exercise programs are important aspects of treatment. We encourage family involvement during therapy sessions. You will receive the education and support you need to care for your child and to continue the therapy program at home. 
• Treatment: May include range of motion to maintain flexibility and maximize movement as well as strengthening, which may include the use of resistive activity, weights and electrical stimulation. Therapeutic taping may also be used to help with positioning of your child’s arm, or orthoses (splints) may be used to support wrist/ hand positioning. Aquatic therapy is always recommended as one of the best ways of maintaining increased function. 
• Botox: If muscle imbalance is present at either the shoulder or the elbow, Botox may be used to help balance muscles of the joint. Botox is injected into the stronger muscle that may be over-powering the weaker muscles. The Botox temporarily weakens the stronger muscles allowing the weaker muscles the opportunity to be strengthened through therapy. The Botox will wear off in three to four months.

Surgical Treatment:

• Primary microsurgical nerve repair may be undertaken as early as 3-6 months of age and isolated nerve repairs up to approximately 18 months. The time frame for surgical repair is an important factor for recovery. Muscles that have not been reconnected to nerves within 18 months of injury weaken to the point where re-innervation may no longer be possible. 
• Secondary procedures may include tendon transfers, muscle transfers and osteotomies to correct muscle imbalances that limit function.