Like all nerves in the human body, those referred to as the brachial plexus are essential to normal functioning. They take signals from the spinal cord and transmit them to the shoulder, arm and hand. Unfortunately, the brachial plexus is very vulnerable on an infant during childbirth. Damage to this nerve cluster can be painful, but may also result in a permanent damage of the limb. While this makes the prognosis extremely important, the nature of a brachial plexus injury can also make it very difficult.
The most important factor when dealing with a brachial plexus injury is early detection. This is the only way that early treatment can occur, which is essential to limiting the extent of the injury.
It is difficult to determine the exact outlook of such an injury because of all the variables at play. In the majority of cases, though, the nerves are not torn, just compressed or stretched. Given the right occupational therapy treatments, most babies can recover from this type of injury within three to six months.
However, in some cases, there is no sign of improvement within this timeframe. That is when a physician may recommend neurosurgery to treat the injured nerves. This happens with roughly 10% of brachial plexus injuries.
One common form of neurosurgery that often works is grafting nerves from one part of the body onto the damaged area of the brachial plexus. A lot of times, this procedure will result in a full recovery.
Unfortunately, it is not known if this kind of intervention will always work. In the case of more serious injuries, surgery may be unsuccessful. Nonetheless, the best chance of it working still only happens when the injury is detected early. While doctors may give it a month or two to heal on its own, between four and nine months old is usually considered the best age for neurosurgery of this kind.
Minor Brachial Plexus Injuries
The prognosis of a brachial plexus injury is determined by where it occurred. If it is simply a stretched nerve (neuropraxia), then the baby should recover on its own. This is actually true of most forms of brachial plexus injuries. All the same, most physicians would still recommend some type of physical therapy if for no other reason than that it can help speed up recovery.
Severe Brachial Plexus Injuries
More severe damage to the brachial plexus, like neuromas and ruptures, demand a more timely combination of surgical intervention and physical therapy. These injuries can also cause long term problems like Klumpke’s and Erb’s palsy. While the baby will always have some impairment of their arm or shoulder, they can still make a very good recovery.
Nerve grafts are, once again, very helpful in the case of an avulsion. However, time is still of the essence. This type of injury is generally difficult to treat and almost always carries with it the certainty of permanent nerve damage and an inability to use the affected arm.
Other Important Factors to Consider
There are a number of other factors that need to be considered as they could lead to a negative prognosis. The main ones are:
- Radial head dislocation as a result of aggressive supination of the baby’s forearm.
- Some infants may actually mutilate their own hands and fingers because of difficulties from their damaged brachial plexus.
- Without proper stretching, children recovering from a brachial plexus injury may be challenged by leftover weakness.
- Muscle imbalances and asymmetrical motor skills could result in scoliosis.
Brachial plexus injuries are fairly common and those that happen the most are the least severe. That being said, there is no one prognosis for any of them which is why you will want to seek medical attention as soon as possible if you think your child is suffering from issues with their brachial plexus.