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Birth trauma and brachial plexus

Enable the normal development of the child

In a natural birth, the baby is pushed through the narrow birth canal. It is therefore normal that some children are born with haematomas. In around 1 to 5 of 1000 live births an injury to the brachial plexus occurs. Brachial plexus injuries are therefore relatively rare. There is a higher risk:

  • among babies with a high birth weight (more than 4000 grams)
  • if a birth takes a long time
  • if a forceps delivery is carried out

Most of the affected babies make a full recovery within two to three months and do not need to be operated on the brachial plexus on account of this. Remaining immobility can, however, lead to contractures, deformation of the bones and ultimately to severe functional restrictions.

DIAGNOSIS OF BRACHIAL PLEXUS INJURIES AMONG CHILDREN

How is a brachial plexus injury in children determined?

Affected children typically have varying degrees of immobility, e.g. shoulder or elbow bend, inability to stretch the wrist, immobility of the hand or complete paralysis of the whole arm. The diagnosis is confirmed on the basis of a clinical examination.

WHEN DOES A CHILD BENEFIT FROM A BRACHIAL PLEXUS OPERATION?

Operations are effective in two cases:

  • If children have complete paralysis of the arm that does not regenerate by the third to sixth month.
  • If children have a lesion on the upper brachial plexus, including if the shoulder mobility and elbow bend are compromised and do not function against gravity at all by the third month or not completely by the sixth month.

We offer you various operative treatment methods for brachial plexus injuries that depend on the severity of the injury. The most common are:

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neurolysis and decompression of the brachial plexus
 

If the nerves were stretched too much during the birth process or if scar tissue exerts pressure on them, it leads to the loss of function of the nerve tissue. It can even cause a scarred deformation of nerves. Through the decompression of the brachial plexus or through microsurgical neurolysis, regeneration of the nerve tissue can be achieved. In case of a cicatricial change to the nerve tissue, nerve transplants are necessary.

Reconstruction of the brachial plexus through autologous nerve transplantation

In autologous transplants, we transplant healthy nerve tissue from the leg of the child to the affected area and can bridge the defect that has occurred.

 

Nerve fibre transfer

The peripheral nerve fibre transfer is carried out in addition to the reconstruction of the brachial plexus or in case of a root avulsion.

Particularities among children with brachial plexus injuries

Developmental and growth disorders due to brachial plexus injuries

 

After birth, the nervous system and other functional systems (skeleton, muscles, fasciae and others) develop further. Apart from a growth in size and length, children must also learn stabilising movement sequences, as well as movement itself.

If the neuroplexus of the arm is injured during birth, all these systems and their development, as well as growth, are delayed and disturbed. For babies it is important to go through all the development stages of normal development.

The normal development of an infant includes the backward movement of the shoulder blade in the ribcage. After birth, the shoulder blades lie relatively far sideways at the rib cage and later wander backwards. For this new placement of the shoulder blade, many shoulder muscles are necessary that are often affected by a brachial plexus injury. As the shoulder muscles are immobilised, the arm is not moved and this development and the growth of the shoulder blade are impeded.

The developmental stage of crawling appears exceptionally important, as this movement on all fours is the basis for the development of adult two-legged walking. The adult walk is only fully developed among children at age six to seven years.

Functional problems

These developmental and growth problems can bring various functional problems. Internal rotation contracture is very common, caused by the typical imbalance of internal rotators that are stronger than the external rotators. The imbalance causes a pathological pressure of the tendons on the humeral head that is pushed backwards out of the joint socket. As the bones are growing, the pathological pressure causes deformations.

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Medical supervision until the end of the growth phase
 

After an injury to the arm neuroplexus, the child must therefore remain under competent supervision until their growth is fully complete. In children up to an age of three to four years, these bone deformations are reversible if the contracture is released and a new muscle and tendon balance is established.

Possible corrections – phase of reconstructive procedures

Up to the age of 14 to 16 years, corrective treatments or operations may become necessary. Various pathologies can develop in the various parts of the extremity:

At the shoulder girdle, the most common are the so-called internal rotation contractures, this means that the arm can no longer be rotated outwards. The treatment includes the release of the contracted elements of the shoulder and the strengthening of the externally rotating muscles.

At the elbow, the most common are contractures of the forearm rotation:

  • Supination contracture (so-called beggar position), pronation contracture (inability to turn the palm of the hand upwards)
  • Bend contracture of the elbow joint (the elbow cannot be adequately stretched out)

At the wrist as well as the hand, various malpositions can also occur. The treatment involves releasing the contracture and optimising the muscle balance. If the restoration of muscle balance is not effective, we also carry out derotation osteotomies. In rare cases, bone lengthening procedures are necessary.

For the optimal development of your child

Through regular check-ups, we keep an eye on the development of your child and can duly intervene if necessary. We always choose the measure that promises the best outcome for your child. This does not always have to be an operation.
In some cases, we can further optimise the functions of the arm and hand with physiotherapy or electrical stimulation.

THE FOLLOWING AWAITS YOU WITH US

A specialised surgical team

A specialised surgical team

A specialised surgical team

A specialised surgical team with many years of experience.

A comprehensive treatment concept

A comprehensive treatment concept

A comprehensive treatment concept

A comprehensive treatment concept based on the knowledge and decades of experience of Prof. Hanno Millesi, which we are continuously developing further on the basis of the latest scientific research findings.

A part of the Wiener Privatklinik hospital

A part of the Wiener Privatklinik hospital

A part of the Wiener Privatklinik hospital

As part of the Wiener Privatklinik hospital, we boast the latest equipment.

experienced interpreters

experienced interpreters

experienced interpreters

On request, we can arrange experienced interpreters.

all-round care

all-round care

all-round care

You are provided with all-round care – from your enquiry until you leave the hospital after your treatment. All the necessary examinations, treatment and care take place at the hospital.

Support you after the treatment

Support you after the treatment

Support you after the treatment

We continue to support you after the treatment and carry out corrective therapies if necessary.

surroundings where you feel competently taken care of

surroundings where you feel competently taken care of

surroundings where you feel competently taken care of

It is important to us to offer you surroundings where you feel competently taken care of and at ease.

PRELIMINARY ANAMNESIS QUESTIONNAIRE

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questionnaire

If you already have a long history of illness behind you regarding your physical complains, we kindly request that you fill in our free questionnaire. Your answers provide us with information about your complaints and your prior medical history. This helps us to prepare your first consultation, to make a diagnosis and to choose the suitable treatment.

FAQ

THE MOST FREQUENTLY ASKED QUESTIONS OF OUR PATIENTS SUMMARIZED.

A complete regeneration is possible, but even so the musculoskeletal development of the child may be delayed.

The children remain under medical supervision until they stop growing.

It is primarily babies with a higher birth weight (more than 4 kg) who have a higher risk of a brachial plexus injury.

The mother and child are generally admitted as in-patients for five days.

Children receive an immobilising bandage for five days. After ten to 14 days, we remove the stitches (intracutaneous suture). After three weeks, physical therapy starts, up to horizontal movements of the shoulder. After six weeks, the full physical treatment starts.

A brachial plexus operation takes between four and eight hours.

The upper brachial plexus injury causes immobility of the shoulder and elbow. This means that the infant is not able, or learns to late, to stabilise the body with the arms when on their front. In addition, normal muscles of the shoulder girdle are functionally disintegrated through the absence of learning the pattern of movement. Learning crawling as a further developmental step and the associated further stabilisation of the shoulder girdle, for example, are essential for the normal development of the shoulder blade and other bones of the shoulder girdle. Due to these developmental hurdles, growth and the learning of sequences of movement can be disturbed and stiffness of the various joint systems can develop. Ongoing physiotherapy with specialised therapists is therefore important so that the affected children can learn movement patterns correctly in accordance with their age.