Neonatal brachial plexus injury is mainly based on the birth history, and is most often seen when the mother is in obstructed labor, when a huge baby usually weighs more than 4 kg, when the baby is head first, when a cephalic suction is used or when forceps are used, resulting in separation of the baby’s head from the shoulder, excessive stretching and injury to the brachial plexus, mostly incomplete. Since most neonatal brachial plexus injuries can be recovered within 1-6 weeks after birth, they can be observed for 6 weeks, and if they do not recover after 6 weeks, they can be seen by a pediatric orthopedic surgeon or a specialized neurologist.
In addition to the physical examination, ancillary tests such as MRI and related neurological studies are needed. Unlike adults, these tests are performed under anesthesia, and if a combined fracture is considered, radiographs of the injury are required.
What happens when a child is diagnosed with a brachial plexus injury?
Once a specialist pediatrician diagnoses a brachial plexus injury in a newborn, the child can be observed for 4 weeks and then seen by a pediatric orthopedic specialist. Most brachial plexus injuries caused by birth injuries are incomplete and have a chance of recovery. The child will be reviewed monthly until the child is 6 months old and will be treated accordingly.
How are brachial plexus injuries treated?
Depending on the severity of the injury, treatment of neonatal brachial plexus injury can be divided into non-surgical and surgical treatment.
1.Observation Most children with brachial plexus nerve injury can heal on their own in the first 3-12 months after birth, and can be followed up regularly and observed closely.
2.Physical and rehabilitation therapy Physical therapy helps to prevent joint and muscle stiffness. Parents of children with brachial plexus injury learn to practice at home under the guidance of therapist to have a maximum range of motion of the joint and pay attention to prevent shoulder joint dislocation when practicing.
3.Botulinum toxin injection (mainly for the shoulder joint) is mainly used to assist joint movement and prevent muscle contracture and dislocation of the shoulder joint by matching muscle strength.
4.Surgery (10-20% of brachial plexus nerve injury requires surgery) Surgery can be considered after 6 months without significant functional recovery, including nerve repair, nerve transfer/transplantation and tendon transfer surgery. Nerve repair surgery is appropriate for children 3-9 months of age, and surgery for children >1 year of age is not ideal. Nerve grafts are usually performed using the peroneal nerve. Tendon transfer replaces the damaged muscle with a normal tendon to restore function, and is used to improve forearm, wrist and hand function, from 1 year of age to adulthood. Shoulder dislocations require shoulder arthrotomy and capsuloplasty.