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Plastic and Reconstructive Surgery

Brachial Plexus clinic

The Brachial Plexus Clinic at The Hospital for Sick Children is a multidisciplinary clinic designed to assess and treat children with brachial plexus problems.

Children are seen in the clinic at three-month intervals until one year of age, then every six months or more thereafter. Your child's progress is monitored and carefully documented in order to determine the best forms of treatment.

Children continue to be monitored in the clinic throughout their childhood to measure the effect of growth and development on their ability to function.

Summary 

The brachial plexus is a group of five nerves that provide movement and sensation to the arm.

It may be affected by a difficult childbirth. The usual course is to allow the nerves to heal and repair on their own. This is a gradual process that may take a year or longer.

In some cases, surgical exploration of the nerves is required to improve the function of the arm. This is done in the first year of life.

Physiotherapists help parents to do range-of-motion exercises with their child and to monitor development and motor progress

Occupational therapists assist in helping children with brachial plexus injuries function to the best of their abilities.

Most children make sufficient progress to achieve good, functional use of their arm. In the majority of cases, however, some residual weakness persists.

The Brachial Plexus Clinic at SickKids provides multidisciplinary care and follow-up for children with brachial plexus injuries from birth to 17 years of age.

Treatment 

The most important factor in the resolution of brachial plexus injuries is time. Injured nerves will often repair themselves well enough to allow full use of the arm. Most nerve and muscle recovery will occur in the first year.

You will notice a gradual improvement in both the movement and strength of your child's arm. Further recovery may happen in the second year, but the effects of increased muscle strength will be much more subtle and difficult to see.

Treatment of a brachial plexus injury involves a team of health care professionals. The Brachial Plexus Team may include a physiotherapist, a plastic surgeon, and an occupational therapist. Click on the links below to learn about the treatments from each team member below.

Physiotherapy

Physiotherapy should be started early in the newborn who has a brachial plexus problem. Therapy will not help the nerves to heal any faster, but it can help prevent problems such as joint stiffness and delays in development.

The therapist will instruct the parents in the proper handling of the baby and about the safest and most comfortable sleeping positions. Parents will also be taught exercises to keep the infant's joints supple and strengthen muscles that are beginning to work.

Physiotherapy visits for patients with brachial plexus problems are scheduled as necessary, usually on a monthly basis for children that require these services.

Surgery

In some patients, surgery can be performed if adequate muscle function has not returned within a reasonable length of time. Children with brachial plexus injuries are carefully monitored during the first year of life to record changes in active joint movement.

If the muscle fails to strengthen beyond a certain point, and the child's ability to move and use the arm is also limited, then the surgeon may recommend an operation to judge the extent of nerve damage.

When the surgeons can observe the brachial plexus directly, the best form of treatment for the nerves can be determined. Surgery done directly on the nerves of the brachial plexus is carried out within the first year of life.

Older children who continue to have major movement problems that limit use of the arm may benefit from other procedures that are applied directly to the muscles and tendons in the affected arm. Examples include tendon transfers, rotation of bone alignment, and muscle transplants.

Occupational Therapy

The Occupational Therapist on the Brachial Plexus Palsy Team has an important role in evaluating how a child with a brachial plexus injury functions in daily activities. This helps the team to provide appropriate recommendations for rehabilitation and surgical planning if any secondary reconstructive procedures are necessary.

Learn more about Occupational Therapy.

How to make a referral 

Community Paediatricians, Family Physicians, Obstetricians, Physiotherapists and Plastic Surgeons can make referrals to the Brachial Plexus Clinic.

Referring professionals accepted

  • Family Physicians
  • Paediatricians
  • Obstetricians
  • Physiotherapists
  • Plastic Surgeons

Initial Visit

  • Usually assessed by our physiotherapist prior to brachial plexus clinic visit
  • Obstetrical lesions are seen by 3 months of age
  • Other injuries are usually seen within 2 weeks, depending on the urgency

Age limit

17 years

Visit the Ambulatory Clinics page for referral form and more information.