Brachial Plexus

A brachial plexus injury is a nerve injury that can cause muscle weakness in your child’s arm or hand, affecting everyday activities such as play, school and self-care. The brachial plexus is a network of nerves that originates in the spinal cord and extends through the neck, shoulder and arm. These nerves control movement and sensation in the upper extremities, including the shoulder, arm and hand.

Injuries to the brachial plexus can occur for several reasons, including trauma, birth injuries and tumors. The severity and type of injury can vary widely—from mild nerve stretching to complete nerve detachment.

The most common types of brachial plexus injuries include:

• Neurapraxia: The least severe type, involving temporary disruption of nerve fibers. Symptoms include weakness, numbness and tingling in the affected limb, often resolving within weeks or months.
• Neuropraxia: This slightly more severe injury also disrupts nerve fibers but requires a longer recovery time—sometimes several months.
• Rupture: A complete tear of the nerve fibers, resulting in total loss of muscle function in the affected limb.
• Avulsion: The most severe type, involving detachment of the nerve from the spinal cord. Often caused by trauma, this type of injury has a poor prognosis for recovery.

Medical Causes

The brachial plexus—a bundle of nerves in the neck area of the spinal cord—can be injured in different ways. In children, brachial plexus injuries most often occur during birth due to stretching or compression of the nerves.

Treatment for brachial plexus injuries depends on the severity of the injury and which nerves are affected.

Surgical Interventions

In some cases, nerve repair may be possible, involving surgical reattachment or repair of the damaged nerve fibers. More severe cases may require nerve grafts or nerve transfers to restore function.

• Nerve Transfers: A healthy nerve, such as the thoracic nerve, may be transferred to restore arm and hand function. The transferred nerve connects to remaining healthy nerve fibers, helping regain muscle movement.
• Nerve Grafts: A healthy nerve from another part of the body is grafted onto the damaged nerve fibers, acting as a bridge to restore function.

The approach depends on the type and severity of the injury, as well as the surgical goals. Recovery timelines can vary greatly—from several months to years—depending on injury level, patient factors and surgical techniques.

Rehabilitation and Recovery

Rehabilitation with physical therapists or occupational therapists plays a vital role in recovery after brachial plexus surgery or injury. The goal is to restore as much strength, range of motion and function as possible in the affected arm, shoulder and hand. Conservative treatments may include:

• Physical or occupational therapy to improve strength and mobility
• Bracing to stretch and maintain range of motion

Therapists may also recommend specialized interventions such as:

• Splinting
• Massage therapy
• Kinesiotaping
• Pool therapy
• Threshold electrical stimulation (TES)
• Neuromuscular electrical stimulation (NMES)

If the injury is severe or not expected to improve with conservative care, your child may be referred for surgical consultation. Mary Free Bed Kids brachial plexus rehabilitation services are available with a prescription from your child’s physician.

Physical therapy is a cornerstone of rehabilitation after a brachial plexus nerve graft.

Occupational therapy focuses on helping your child adapt daily activities—dressing, grooming, eating and play—using the affected arm. Your Mary Free Bed therapist will guide exercises to improve range of motion, strength and coordination, including stretching, strengthening and fine motor skill activities like gripping and grasping.

The start of rehabilitation depends on the type of surgery and your child’s healing progress. Therapy often begins a few weeks after surgery and gradually increases in intensity and duration. Recovery may take many months or even years and could involve additional interventions along the way.

Your Mary Free Bed therapist will help set realistic goals and develop a personalized treatment plan to support your child’s individual needs and progress.

If your child has experienced a brachial plexus injury, our expert Pediatric Rehabilitation Team is here to help. Contact Mary Free Bed Kids today to schedule an appointment and begin your child’s journey toward recovery and independence.

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