Strain or compression of the fetal brachial plexus nerve during delivery is the main cause of brachial plexus injury in newborns, most commonly injury to the brachial trunk. If an infant is born with asymmetrical movements or dysfunction of the upper extremities (from the shoulder to the fingers) on both sides, for example, the shoulder joint cannot be abducted and lifted, the elbow joint cannot be flexed but can be extended, and the wrist joint can be flexed but has reduced muscle strength, the infant should be considered to have brachial plexus injury (i.e., birth palsy).
Because brachial plexus injury is often combined with peribrachial plexus hemorrhage and finally adhesion scarring, if early treatment can prevent adhesion and prevent scarring, and can stimulate peripheral nerve recovery as soon as possible. Therefore, for neonatal brachial plexus injury, passive observation is better than early treatment, the earlier the treatment, the less scar formation, therefore, early rehabilitation is advocated. If there is no significant recovery in clinical examination and electromyography after 3 months to 6 months of conservative rehabilitation, surgical treatment can be considered.
The purpose of brachial plexus injury rehabilitation treatment is to prevent and treat comorbidities, promote the regeneration of damaged nerves, maintain muscle mass, promote the recovery of motor function and sensory function, and finally restore the patient’s ability to care for himself.
In the process of clinical care, the following major features are summarized: 1. Application of neurotrophic drugs, such as: Vitb6, Vitb1, dibazol and other oral medications. Intravenous medications such as cytarabine to restore nerve cells are administered in a course of treatment, generally ten days as a course of treatment.
2.Promote the recovery of sensory function: physical therapy at the site of injury, such as: electrical stimulation therapy, magnetic therapy Bid, and can be combined with acupuncture, massage, massage, conducive to the elimination of nerve shock, the release of nerve adhesions and joint relaxation, etc.
3.Training to enhance muscle strength: functional exercises for the affected limbs, such as: forward rotation and backward rotation of the arm, abduction and supination of the shoulder joint, internal and external rotation of the elbow joint, flexion and extension of the wrist, and auxiliary exercises such as supporting the body with the palm of the hand when the body is in the seated or lying position. When the affected muscle strength increases to 3-4 levels, resistance exercises can be performed to maximize the recovery of muscle strength.
4.Protection of sensory loss: The damaged limb is vulnerable to further bruises or burns, and it is more difficult to repair the skin injury after the loss of innervation, so it is necessary to protect the innervated skin and avoid scalding and pressure injuries.
5, the care of swelling: brachial plexus injury of the limb muscle loss of motor function also lost to the limb when the venous squeeze reflux role, especially the limb in a drooping position and extreme flexion of the joint when the swelling is more pronounced, to often carry out passive muscle activity and change the joint position, appropriate elevation of the affected limb with warm water hot compresses, passive stretching should be slow, the range should be ashamed to increase, avoid rough, so as not to cause new injuries Do not be violent to avoid new injuries.
6, regular electromyographic examination, not only is conducive to the identification of nerve recovery, and electromyographic stimulation is conducive to nerve regeneration.
After three months of rehabilitation treatment, the child’s shoulder, elbow and wrist joint mobility can generally be enhanced, arm support force increased, muscle strength increased. This proved that the effect of rehabilitation treatment was significant. However, after 3 months of conservative treatment, those with no improvement in the shoulder and elbow joints due to birth-induced upper brachial plexus stem injury can be considered for surgical treatment.