ROMMER
Condition

Brachial Plexus Injury

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What Is Brachial Plexus Injury?

The brachial plexus is a network of nerves that originates from the spinal cord at the level of the neck and controls movement and sensation in the shoulder, arm, and hand. Brachial plexus injury is a condition in which these nerves are stretched, torn, or compressed, usually due to birth trauma or accidents, resulting in partial or complete loss of function in the arm. In children, it most commonly occurs during difficult deliveries (shoulder dystocia, forceps or vacuum-assisted delivery).

Types of Brachial Plexus Injury

  • Erb's Palsy (Upper Trunk - C5-C6): The most common type; shoulder and elbow movements are primarily affected. The arm hangs by the side, rotated inward (waiter's tip position).
  • Klumpke's Palsy (Lower Trunk - C8-T1): Wrist and finger movements are affected; hand grip is weak.
  • Total Plexus Injury: The entire arm is affected; all movement and sensation is lost.

Rehabilitation at ROMMER

Brachial plexus rehabilitation in children must be started as early as possible — ideally within the first weeks of life. At ROMMER, treatment is planned according to the type and severity of the injury:

  • Range of Motion Exercises: Passive and active-assisted movements are applied daily to prevent contracture of the shoulder, elbow, wrist, and fingers.
  • Neuromuscular Electrical Stimulation (NMES): Electrical impulses are used to stimulate recovering nerve-muscle connections and prevent muscle atrophy.
  • Constraint-Induced Movement Therapy (CIMT): The healthy arm is temporarily restrained so the affected arm is actively used, increasing its functional capacity.
  • Sensory Stimulation: Tactile stimulation programmes such as massage, brushing, and various textures are used to support sensory recovery.
  • Developmental Support: Developmental guidance and family training are provided to ensure the infant reaches motor milestones appropriate for age.
  • Surgical Planning: In cases not responding to conservative treatment, nerve repair or muscle-tendon transfer surgery is planned in collaboration with the neurosurgeon and paediatric orthopaedist.

Long-Term Prognosis

Early-diagnosed and intensively treated cases have a good prognosis; the majority of children with Erb's palsy show significant functional recovery within the first year of life. In more severe injuries, long-term rehabilitation and sometimes surgical support may be needed. At ROMMER, periodic evaluations track the child's progress and the programme is updated accordingly.

Frequently Asked Questions

When should rehabilitation start after brachial plexus injury?+
As early as possible — ideally within the first 1–2 weeks of life. Early physiotherapy prevents contractures, supports nerve regeneration, and maximises the child's recovery potential.
Will my child regain full arm function?+
This depends on the type and severity of the injury. Children with Erb's palsy (C5-C6) often achieve near-normal function with early rehabilitation. Total plexus injuries have a more variable prognosis and may require surgery alongside long-term therapy.
What is constraint-induced movement therapy (CIMT)?+
CIMT involves temporarily restricting the use of the unaffected arm (usually with a soft cast or mitt) to encourage the child to use and develop the affected arm. It is particularly effective in children aged 2–8 years with mild to moderate upper limb involvement.
At what point is surgery considered?+
If there is no meaningful motor recovery in key muscle groups by 3–6 months of age (depending on injury severity), nerve grafting or neurotisation surgery is typically discussed. Muscle-tendon transfers may be considered later to improve specific movements like shoulder external rotation or elbow flexion.

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