Brachial Plexus and Peripheral Nerve Clinic

At Phoenix Children’s, we offer innovative and state-of-the-art treatments to help your child recover from brachial plexus and peripheral nerve injuries.

Our experts will evaluate and diagnose the cause and severity of your child’s injuries. Your child’s prognosis and care depend on the specific nerves affected and how badly they were damaged. We develop a tailored treatment plan to address your child’s specific needs. Treatments may include:

  • Physical and occupational therapy
  • Medications to manage pain
  • Splints and bracing
  • State-of-the-art nerve stimulation techniques
  • Surgery, including our innovative surgical options for brachial plexus and peripheral nerve injuries

Not every child with brachial plexus or peripheral nerve injuries need surgery. In fact, many do not. If your child’s nerve injury is mild or good nerve regeneration/recovery is taking place, your doctor will monitor the injury closely with conservative therapy such as physical or occupational therapy services. Many brachial plexus or traumatic nerve injuries heal on their own without surgery over weeks to months with good or full restoration of function.

If your child’s injury is severe or recovery is not happening within two or three months after the time of initial injury, your doctor may consider surgery. To determine whether surgery will help, your child’s neurosurgeon or plastic surgeon may order magnetic resonance imaging (MRI) and nerve testing, using an electromyogram and nerve conduction studies to measure the electrical activity in the muscles and nerves.

How Physical and Occupational Therapy Help Your Child Recover

To help your child recover as much function in the arm and hand as possible after a brachial plexus injury, your child’s doctor will recommend occupational or physical therapy, or both.

Children typically have the best chance to regain function if they start therapy soon after the injury occurs. Therapy encourages movement and helps to prevent joint and muscle stiffness.

At Phoenix Children’s, we offer outpatient therapy for children with brachial plexus and peripheral nerve injuries.

Occupational therapy helps your child:

  • Build fine motor skills (the coordination of nerves, muscles and bones to produce small, precise movements).
  • Practice activities such as writing with a pencil, stacking blocks, coloring, turning pages of a book and cutting out shapes with scissors.
  • Perform activities of daily living, such as getting dressed, brushing teeth and eating a meal.
  • Increase range of motion and strength in the upper body.
  • Learn to adapt toys and activities so they can move and play.

Physical therapy helps your child:

  • Build gross motor skills (the ability to make large, general movements that require proper coordination and function of the nerves, muscles and bones).
  • Maintain or increase arm strength, muscle flexibility and range of motion.
  • Participate in activities such as crawling, sitting, standing, jumping, running, playing sports, riding a bike and swimming.
  • Adapt toys and activities so they can move and play.

Your child’s physical and occupational therapists will work closely with you and your child. Your therapist will show you how to encourage your child to incorporate movement of the arm and hand into age-appropriate games and activities at home.

During the course of your child’s physical and occupational therapy, your therapist may recommend certain bracing devices or advanced stimulation treatments, including:

To support a limp arm and joints.

Involves using devices to encourage the affected arm's use, rather than the arm not impacted by the injury.

To activate nerve fibers, strengthen muscles and prevent muscle loss and tightening.

A cycle for arms and legs that uses mild electrical current to stimulate the nerves, promote injured nerve regeneration and prevent muscle loss.

Not every child needs these treatments. Your child’s specialists and therapist will help you determine which interventions will be the most beneficial.

If your child has surgery, therapy is essential afterward so we can monitor scarring and help your child maintain range of motion and perform routine tasks.

Surgery

Many children with brachial plexus and peripheral nerve injuries will regain function and feeling in their arms and hands over time with physical and occupational therapy. For others, the right course of treatment is surgery.

To determine whether surgery will help, your child’s surgeon may order magnetic resonance imaging (MRI) and nerve testing – using an electromyogram and nerve conduction studies to measure the electrical activity in the muscles and nerves.

If the injuries to your child’s nerves are severe, particularly if there are nerve tears or ruptures, your doctor may recommend a surgical procedure.

Common surgical treatments for brachial plexus or peripheral nerve injuries include:

Surgeon removes scar tissue from around the injured nerves because scar tissue may be compressing the nerves; goal is to relieve pain and disability.

A healthy nerve is taken from another part of the body and sewn between two ends of a ruptured nerve; may use artificial or cadaver nerve tubes; the nerve graft acts as a bridge between severed nerve ends; goal is to create paths for new nerve connections.

Functional nerves are transferred to non-functional nerves; goal is to regain function by providing a signal to a paralyzed muscle.

The tendon of a functioning muscle is sewn into a nonfunctioning muscle tendon to restore a specific motion or motor function; used to improve function when nerve surgeries do not work.

When disability persists into early childhood, muscle transfers are a microsurgical reconstructive option that involves moving a muscle from another part of the body, typically the leg, to restore motion in the arm.

Bone and joint surgeries can help reposition the arm and hand into a more functional or stable position to optimize the motion available to a child.

When Should My Child Have Surgery to Repair the Nerves?

Your child’s surgeon will determine the best time for your child to have surgery. Often, surgery takes place between three and six months after the injury, allowing time for the shoulder, arm or hand to regain as much movement and strength as possible on its own.

Also, the nerves will react to surgery best during this time frame and have a higher chance of reaching the muscles they are supposed to reach for nerve reconnection.

If surgery is delayed too long, your child may be at risk for:

  • Insufficient nerve recovery, where the arm may become “stuck” in a position that does not allow child to perform normal tasks and activities of everyday living and play
  • Incomplete growth of the arm
  • Differences in function and capability of the arms
  • Chronic pain

After Your Child’s Surgery

  • Your child may need to wear an arm sling or a cast, allowing the arm, nerves, muscles and tendons to heal properly.
  • Your child’s surgeon will instruct you on how and when you should move your child’s arm.
  • You and your child will have follow-up visits with the surgeon to assess how your child is healing.
  • Your surgeon will recommend occupational or physical therapy after your child has healed sufficiently. Therapy is essential to maintain range of motion, monitor scarring and help your child regain the ability to use the arm to perform tasks.

Frequently Asked Questions

The brachial plexus is a network of nerves in the base of the neck behind the collarbone. These nerves cross the upper chest to the armpit and extend into the arms and hand. There is a brachial plexus on each side of the body. A sudden injury to the brachial plexus can reduce the movement, strength and sensation in your child’s arm, hand and fingers. Usually, a brachial plexus injury involves only one side of the body.

The brachial plexus is part of the peripheral nervous system. The peripheral nerves branch off the brain and spinal cord, sending messages throughout the body. They signal muscle movement, heartbeat, sensation and other body functions. An injury to the nerve interferes with those signals. While brachial plexus injuries cause loss of function in the arm and hand, other peripheral nerve injuries may cause problems in other parts of the body, such as balance and walking issues.

If your child has a brachial plexus injury, you might observe their arm looking limp or even paralyzed. Additionally, there could be noticeable problems with their shoulder, arm, or hand, including:

  • Loss of movement and muscle control
  • Weakness
  • Pain
  • Numbness, loss of feeling and sensation
  • Trouble sensing temperature changes or pain to the touch

Injuries to the brachial plexus and peripheral nerves occur when the nerves are stretched, compressed, damaged or torn – either before or during a baby’s birth or during a traumatic accident later in life.

A Difficult Childbirth – Some babies suffer peripheral nerve injuries during pregnancy or during the birth and delivery process. Referred to as a congenital brachial nerve palsy or plexopathy, this is the most common type of brachial nerve palsy seen.

Traumatic Accidents and Injuries – Children also suffer brachial plexus and peripheral nerve injuries during falls, sports injuries or traumatic accidents, often involving all-terrain vehicles, bikes, cars or motorcycles. The nerve fibers of the brachial plexus are stretched or torn when the child’s shoulder is pressed down forcefully and the head is pushed up and away from the shoulder.

Chronic Compression – Some children suffer peripheral nerve damage when the nerves are chronically compressed for numerous reasons, such as what happens when they have carpal tunnel, cubital tunnel or thoracic outlet syndrome.