BRACHIAL PLEXUS BIRTH PALSY

WHAT IS BRACHIAL PLEXUS:

The brachial plexus is a complex of nerves which originate from the neck and goes to the shoulder. These nerves control the muscles of arm, hand, shoulder, chest and sensations in the upper limb.

BRACHIAL PLEXUS BIRTH PALSY:

Brachial plexus birth palsy is an injury to the nerves of brachial plexus (C5-T1) during the process of delivery. This palsy occurs in 1 to 3 children out of 1000 live births.

During difficult delivery the nerve gets stretched, compressed or torn leading to weakness or paralysis of the muscles of  arm, elbow and hand.

This injury may affect the entire brachial plexus or its upper or lower divisions[Upper brachial plexus (C5-C6) and lower brachial plexus (C7-C8-T1)].

 

  

 

TYPES OF BRACHIAL PLEXUS INJURY:

  1. NEURAPRAXIA (STRETCH TO THE NERVE)

is the mildest form of injury. It is a stretch injury that results in blockage of nerve conduction and weakness of the upperlimb. In majority of cases, all the movements fully recover in 6-8weeks.

 

  1. AXONOTMESIS (RUPTURE)

It is more severe than neurapraxia with complete internal disruption of axon and loss of axonal conductivity. Near full functional recovery is expected but can take several months or even a year.

 

  1. NEUROTMESIS: (AVULSION)

Severe form of nerve injury in which nerve is completely transected resulting in complete paralysis, muscle atrophy and loss of sensation over area supplied by that nerve.

 

ROLE OF PHYSIOTHERAPY IN BIRTH PALSY BRACHIAL PLEXUS INJURY:

Physiotherapy plays an important role in brachial plexus treatment. Physiotherapy is usually started after 6 weeks of birth but we should start passive range of exercises as soon as possible after birth to gain muscle strength and to prevent contractures.

Electrical stimulation helps in preventing atrophy of the motor nerve endings.

 

  1. Electrical stimulation:

Neuromuscular electrical stimulation used as a rehabilitation adjunct to promote nerve regeneration following brachial plexus injury.  It enhances muscle activation in a weak or poorly innervated muscle group. It also helps in inhibition of muscle atrophy during the period of re-innervation.

  1. MANUAL THERAPY:

Manual therapy is used to maintain or improve muscle strength, to prevent or reduce joint contracture and to increase daily activity.

Passive range of exercise, active assisted exercise and active exercise (by performing several tasks with the help of toys and different gadgets) are helpful in the recovery of brachial plexus palsy.

 

NOTE:   All the exercise programme should be play based exercise activity.

 

ORTHOSIS:

In the rehabilitation of brachial plexus palsy orthosis helps to prevent contractures like elbow contracture, pronater tightness, internal rotator tightness etc.

 

WHO NEEDS SURGERY:

Children with panplexpathy(flaccid limb) with no progressive improvement on physiotherapy and electrical stimulation need nerve reconstruction surgeries.

 

 

 

 

 

 

 

 

 

 

 

 

Author: tritonhospital

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