Fortunately, most peripheral nerve injuries will resolve on their own. Physical or occupational therapy and time can also greatly help the damaged nerves to likely heal themselves. However, if by 2-3 months from the time of injury there is little or insufficient recovery of function, then surgery may need to be considered. WVU Medicine Children’s Brachial Plexus and Peripheral Nerve Clinic is the best place to take your child as we have a number of advanced surgical options available, including nerve grafting.
Surgical Options Available
The need for surgery will be determined by your child’s neurosurgeon. Your child’s doctor may order imaging such magnetic resonance imaging (MRI) or nerve testing (electromyogram, nerve conduction studies) depending on the severity of the injury and recovery time in order to choose the best treatment options.
Common surgical interventions for brachial plexus injuries performed at WVU Medicine Children’s include:
- Nerve grafts: using one’s own nerves, artificial, or cadaver nerve tubes to create channels for new connections to grow through
- Neurolysis/ neuroplasty: remove scar tissue from around the nerves or compressing the nerves
- Nerve transfers: transferring parts of functioning nerves to non-functional nerves to try and regain function
- Tendon releases and/or transfers: used when “nerve” surgeries do not take or are not an option to improve function
- Muscle transfers
- Joint and/or limb reconstructions
Timing of the primary surgery to repair the nerves will be determined by your child’s neurosurgeon, but often takes place between 2-6 months after the injury in order to gain as much movement and strength back as possible. 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 put off for too long, your child may be at risk for:
- Insufficient nerve recovery resulting in an arm becoming “stuck” in a position which prevents completion of normal every-day tasks
- Incomplete growth of the arm
- Differences in function and capability of the arm
- Chronic pain
- Your child’s arm may be placed into either a sling or a cast in order to allow the arm and the nerves, muscles and tendons to properly heal.
- Your child’s surgeon will instruct you on how and when you should move your child’s arm.
- You and your child will be scheduled to attend follow up visits with the surgeon and your therapists in order to assess healing progress.
Physical and Occupational Therapy
Your child’s doctor will be recommending your child receive occupational therapy, physical therapy, or both therapy services in order to gain as much function in your child’s arm as possible.
Occupational therapy addresses fine motor skills, activities of daily living, and range of motion and strength of the upper body. Physical therapy addresses gross motor skills such as balance, coordination and posture. Your child’s doctor will determine the appropriate therapy services and frequency of these services based on your child’s specific needs.
Your child’s therapist will work closely with you and your child in order to address the use of your child’s arm in age-appropriate tasks such as playing with toys, self-feeding and dressing. The therapist will also recommend ways to incorporate movement, strength and functional use of your child’s arm into activities that you can complete with your child at home.
It is often suggested children with incomplete injuries receive occupational and physical therapy services before determining if surgery is required. Beginning therapy services soon after the injury occurred gives your child’s arm the best chance of functional recovery. If therapy services do not result in functional improvements with your child’s arm, such as your child being able to bring their hand to their mouth, your child’s therapist and doctor will collaborate to determine if surgical intervention is appropriate. Participation in therapy services is also essential after your child has healed from surgery in order to maintain range of motion, monitor scarring and increase focus on functional tasks.
Outpatient occupational and physical therapy services are available for children with brachial plexus and peripheral nerve injuries here at WVU Medicine Children’s. We offer state of the art equipment and interventions for the rehabilitation of your child’s brachial plexus and peripheral nerve injury. Your child’s therapist will help you determine which interventions will be the most beneficial.