When a brachial plexus injury occurs during the birth process, a network of nerves that sends signals from the spine to the shoulder, arm and hand are affected. These injuries most often occur during delivery (generally in babies greater than 9 pounds) when the shoulder is stretched during passage through the birth canal.
Because brachial plexus injuries are caused by nerve damage, symptoms of weakness or limpness; problems moving the arm, wrist or hand; and loss of sensation or numbness are common. Diagnosis begins with a comprehensive physical exam including medical and developmental history and imaging.
At the Johns Hopkins All Children’s Hospital Peripheral Nerve Clinic, we provide brachial plexus and peripheral nerve care with the only multidisciplinary team of experts in the state of Florida to help minimize and correct these injuries.
Diagnosis and testing
- Visit with your pediatrician for a comprehensive physical exam if you feel your child has any of the above symptoms. Your pediatrician will determine if a referral to a specialist is needed.
- Diagnosis involves the medical history, developmental history, neurological exam and physical exam.
- Diagnostic tests such as magnetic resonance imaging (MRI) of the brachial plexus and/or cervical spine and electromyogram (EMG) to assess muscle contraction may be used.
Why Choose Johns Hopkins All Children’s Hospital?
- We coordinate care from a team of specialists, including those from neurosurgery, orthopedics, pediatric rehabilitative medicine, physical and occupational therapy and other specialties as needed.
- The clinic is run by the world-renowned peripheral nerve neurosurgeon Dr. Allan Belzberg, a professor of neurosurgery at Johns Hopkins University, and Dr. Lee Phillips, orthopedic surgeon.
What to Expect
Your child’s first visit will include a meeting with a pediatric rehabilitation specialist and a member of the neurosurgery team. They will perform the initial screening, or record review for out-of-state patients.
A second visit typically consists of a consultation/evaluation by neurosurgery, orthopedics, plastic surgery, pediatric rehabilitation and occupational therapy team members.
After the consultation, the brachial plexus team will meet to plan the best treatment for your child and will work with your family to implement this plan.
Some patients will recover spontaneously or at least improve significantly within a few months. For our patients who need further treatment:
- Nonsurgical treatments, including physical therapy, may be used to promote nerve recovery, to strengthen muscles and to improve range of motion.
- Surgical treatments include: Surgical exploration, neurolysis (releasing nerve from the scar), nerve grafting (using a healthy nerve to bridge a nerve gap) and nerve transfers (using working nerves to stimulate nerves and muscles.)
If Your Child Needs Surgery
- If your child is found to be a surgical candidate for repair of their peripheral nerve injury, the patient will be admitted the morning of surgery. After surgery, most of the children will be admitted to the general pediatric neurosurgical floor for 24-48 hours of observation and post-operative pain control.
- Post-operatively, most children go home on over-the-counter pain reliever as needed for discomfort.
- We will see the child in post-operative clinic about two weeks after surgery to make sure he or she is healing appropriately.
We know you want what's best for your child. We're ready to assist you with your questions.
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