These are the five most frequently asked questions at the Brachial Plexus Program at Miami Children's Hospital.
- What causes congenital brachial plexus palsy?
- My 6-month-old has Erb's Palsy. Surgery has been recommended. If the surgery is successful, will my child have a completely normal extremity?
- What is the result of taking nerve grafts from the legs to reconstruct the brachial plexus injury?
- Will therapy help my child's brachial plexus injury?
- How long does my child need therapy?
1 - What causes congenital brachial plexus palsy?
Congenital brachial plexus palsy may occur due to trauma during delivery, trauma before delivery, amniotic bands, or congenital chicken pox. The majority of cases of congenital brachial plexus palsy are due to trauma during delivery. Most of these neonates have a clear history of shoulder dystocia and evidence of acute trauma to other areas of the body. Trauma prior to the initiation of labor should be suspected as the cause of brachial plexus palsy in small neonates delivered by cesarean section and without evidence of acute trauma. Most of these neonates have fixed deformities of the extremity that implies that the limb movements have been restricted for a prolonged period of time. The presence of fibrillation by electromyography in the first week of life is strong evidence that the injury occurred prior to delivery. Fibrillation does not occur until 10 days after nerve injury. Amniotic bands in the distribution of the shoulder and neck may produce brachial plexus palsy. The presence of an amniotic band is diagnostic. The affected arm is usually deformed and only partially developed. Chicken pox as the cause of brachial plexus palsy should be considered in neonates born to mothers that develop chicken pox during early and middle pregnancy. Neonates with congenital chicken pox have cutaneous scarring which results from exposure of the vesicular lesions to amniotic fluid.
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2 - My 6-month-old has Erb's Palsy. Surgery has been recommended. If the surgery is successful, will my child have a completely normal extremity?
It is highly unlikely that surgical reconstruction of an obstetrical brachial plexus injury will allow a child to ultimately have an absolutely normal extremity, symmetrical with the uninjured side. In many cases, however, an initially successful repair of the nerves, coupled with appropriate secondary reconstructive procedures on the shoulder, results in an extremity that, while not perfect, has an extremely high level of function and active range of motion. At rest, the extremity appears to be completely normal with no significant limb length discrepancy.
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3 - What is the result of taking nerve grafts from the legs to reconstruct the brachial plexus injury?
There is no real deleterious effect from removing the sural nerve grafts, except for minor scarring on the posterior aspect of the leg. Occasionally there is a small area of numbness on the foot; however, it is extremely unusual for a patient to even notice. In our experience, we have never encountered a complication or a complaint aside from the scarring.
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4 - Will therapy help my child's brachial plexus injury?
Yes! Therapy will provide your child with a program that focuses on increasing active and passive range of movement and promoting use of the weak arm for functional activities. If necessary, an appropriate splint will be provided. The therapist will be able to assist you in planning care for your child.
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5 - How long does my child need therapy
Occupational and/or physical therapy are usually indicated when the child is diagnosed. Therapy will depend on the child's recovery of active movements. If a child has spontaneous recovery (full active movements) within 3 to 4 months, parents/caregivers are usually given a home program before discharge. However, if spontaneous recovery does not occur, your child will be seen in therapy. The doctor and the therapist will determine how long your child will require therapy. In most cases, once the child is seen in therapy, she/he will be given a home program that will be reviewed with the parents/caregivers. It is of utmost importance that these home programs be performed consistently. The therapist's role is to guide the parents/caregivers as they are the ones who will work with the child on a daily basis. It is crucial that follow-up with the doctor be arranged once the child is discharged from therapy.
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