Brachial Plexus and Peripheral Nerve Clinic

We offer innovative treatments to help your child recover from brachial plexus and peripheral nerve injuries.

Our experts first will evaluate the severity of your child’s injuries. We may use magnetic resonance imaging (MRI) and other special tests to see the injured area and check the function of the nerves. Your child’s prognosis and care depend on the specific nerves affected and how badly they were damaged. 

Then, we’ll design a treatment plan to address your child’s specific needs. Treatments may include these and others:

  • Physical and occupational therapy
  • Medications to control pain
  • Splints and bracing
  • State-of-the-art nerve stimulation techniques
  • Surgery

Healing Without Surgery

Not every child with brachial plexus injuries needs surgery. In fact, many do not.

If your child’s nerve injury is mild, your doctor will monitor the injury closely. Many brachial plexus injuries heal on their own over a period of weeks to months.

For example, when brachial plexus injuries happen at birth, many infants will recover the ability to move their arms and hands within several months. Your doctor might suggest you perform daily physical therapy exercises with your infant to help develop maximum function.

Our goal is to find out whether the injury will heal and your child will regain function without the need for surgery. Fortunately – whether nerve injuries happen during birth or during a traumatic accident – many symptoms will resolve without surgery.

Learn how physical and occupational therapy can help children regain function after a brachial plexus injury.

If your child’s injury is severe or recovery isn’t happening within two or three months after the time of injury, your doctor may consider surgery. Learn about our innovative surgical options at Phoenix Children’s.

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.

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

  • Custom splint fabrication to support a limp arm and joints.
  • Modified constraint-induced movement therapy involves using devices to encourage the use of the affected arm, rather than the arm which was not impacted by the injury.
  • Neuromuscular electrical stimulation to activate nerve fibers, strengthen muscles and prevent muscle loss and tightening.
  • RT300 functional electrical stimulation bike that uses mild electrical current to stimulate the nerves in the arms and legs. This promotes injured nerve regeneration and prevent muscle loss.

Not every child needs these treatments. Your child’s doctor 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.  

If Your Child Needs 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 neurosurgeon 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 injuries include:

  • Neurolysis/neuroplasty: Surgeon removes scar tissue from around the injured nerves because scar tissue may be compressing the nerves; goal is to relieve pain and disability.
  • Nerve graft: 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.
  • Nerve transfers: Functional nerves are transferred to non-functional nerves; goal is to regain function by providing a signal to a paralyzed muscle.
  • Tendon releases and/or tendon transfers: 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.
  • Muscle transfers: 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.
  • Joint and/or limb reconstructions: 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.

Your child’s neurosurgeon 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 timeframe 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 doesn’t 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.