Damage to the brachial plexus nerve and each branch can cause upper limb and hand movement and sensory disorders, affecting hand function, so comprehensive rehabilitation treatment has an extremely important role in restoring the limb.
I. Phase I (after injury to before surgery) 1. Clear diagnosis of various etiologies of hand function motor sensory impairment and other symptoms that appear, such as inflammation, edema, limb numbness, painful limb contracture, unfavorable joint movement, etc.
2.Rehabilitation requirements. To address the causes: anti-infection to eliminate inflammation, accelerate edema absorption, reduce nerve compression, promote nerve regeneration, flexible joints, stop pain, appropriate progressive movement of the limb, including passive movement. Prevent joint stiffness and muscle atrophy, and improve and reduce contracture.
[Measures] 1. Antibacterial drugs, blood-activating and anti-swelling drugs, nerve-nourishing drugs.
2.Physiotherapy (infrared, laser, low-frequency electrotherapy, neuromuscular therapy, neuromuscular electromyography, tui-na, etc.).
3.External fixation brace (plastic splint), power brace, plaster, splint.
4.Diverse trainers for hand function, etc.
5.Regularly check electromyography to observe the nerve repair status.
Second phase (after surgery) 1.In the early preoperative period, or after the rehabilitation process, other abnormalities such as inflammation and edema have subsided, but the limb function has not been fully restored, or the phenomenon of muscle atrophy has appeared, the sensory-motor nerve has not yet restored normal conduction function, the limb contracture has increased, and the stiffness of each joint has appeared.
2.Rehabilitation requirements. For the above symptoms after the first stage (including postoperative), what is needed is to prevent muscle atrophy and enhance muscle strength, improve joint stiffness and limb contracture and scar growth, etc. (such as tiger mouth contracture that makes the tiger mouth narrower) to speed up the stimulation of nerve conduction function, promote nerve cell regeneration, and enable early recovery of hand function.
[Measures] Nutritional nerve drugs, physiotherapy can promote local blood circulation, improve local nutrition and promote active nerve cells, repair and regeneration, assist in the recovery of hand function of neuromuscular electrical stimulation and other rehabilitation instruments. Strengthening the passive movement of limb joints by manipulation and massage to loosen the joints, reduce adhesions and stiffness, and help paralyzed muscles to improve muscle elasticity by electrical stimulation and massage. Selective stimulation of nerve trunks, promotion of faster conduction, use of various hand function therapy equipment, traction and progressive resistance method to pull apart the contracted limb, increase mobility and muscle strength, as well as with preoperative and postoperative selective training of various kinds to suit the needs of tendons, muscle transfer and compensation. Orthopedic devices such as wrist extensions, finger extensions, power braces, and various shaped splints are used to maintain good limb position and prevent limb deformity.
For each patient with brachial plexus injury, we need to guide and design a set of rehabilitation training program that is conducive to the recovery of the affected limb and is effective in promoting functional recovery and enhancing the courage of the patient to overcome the disability and rebuild the function, from passive movement to active movement of the muscles innervated by the upper limb nerves and the shoulder, elbow, wrist and metacarpophalangeal joints –progressive resistance exercise – to restoration of function. (Fine motor training and sensory training of the hand are also of paramount importance).