brachial plexus injury

[spandanphysio]

Hello friends I'm dealing with a 3 months old baby having suffered a brachial plexus injury on right side during birth. Her E.M.G report shows normal rhomboidus, 1st dorsal interossei and abductor policus brevis. Spontaneous activities seen in rest of muscles with no sign of regeneration yet.N.C.V shows absent all 3 main nerve of upper limb. So how much time will she take if she is having axonotemesis? Should v go for M.R.I? What's your opinion regarding surgery? Are surgical results satisfactory?

[emad]

Why thinking of surgical at this stage of 3 times old , long time then thinking of surgery after 2 years still there is chance of regeneration .Justt need good handling professionally and from the mother , gentle approach and encourging of this limb using to the point of preventing sound limb use as induce-therapy !

cheers
Emad

[spandanphysio]

hi emad thanx for rply.don't u think 2 year is a very long duration for her?how can v know if it's complete evulsion?i forgot to mention in e.m.g study that it shows involvement of c5,c6 and c7 nerve root.she has been advised for end to end suturing between age of 3 to 9 months by child neuro physician.

[emad]

Well. I used to depend mainly on motor evaluation of muscle power to know the degree of nerve injury ,but seems you depend on doctors and surgeons reports of EMG . So i can not know from you what the degree of nerve injury except you tell me what the child can do as hand closure and opening ...it is really difficult without seeing the child !!!!

cheers
Emad

[spandanphysio]

u r right emad main difficulty is that v r not able to see pt here.well she can close fist with wrist flexion.can pronate the elbow and addudt the shoulder.

[estherderu]

dear everybody,

especially for people not being able to see a physiotherapist... patient information is important.
I suggest you go to page 2 for my anwer to a similar question.
Thread newborn diagnosed with Erb´s Palsy,
and the following guidelines will be of some help.
http://www.ubpn.org/awareness/A2002storment.pdf

good luck to you all

kind regards

Esther de Ru

[emad]

Well, Early Surgical intervention is appropriate in severe flaccid cases which result from complete avulsion of the roots , however this is not common . So that ,giving chance for regeneration and Gentle handle of rehabailitation is good choice .I saw many cases and fallowed them ,what concerns me really the child tends to use the non-affected limb and that problem can not be approached through surgery because it is just behavior !!!

cheers
Emad

[spandanphysio]

hello esterderu thanx for link.

[spandanphysio]

hello friends after 5and half month my pt can flex hand to 45 degrees.she was reffered to peadiatric ortho and neuro.ortho says that as it is c5,c6 ,c7 involvement we should wait for another 1 month if some recovery occurs in related roots.i think baby can perform gravitiy eliminated elbow flexion with shoulder flexion but orto says that it's a tric movt. using internal shulder rotation.than if she doesn't recover planed for nerve transefer.while neuro says for immediate surgery for end to end suture as it's a already to late.what should be done?should v wait for recovery?is it primary surgery better than late age secondary surgiries?pls help us...

[estherderu]

dear colleague,
the questions you are asking are not that easy to answer and I would personally prefer to ask the childs´specialists.
There is a lot of information about surgery and I do not know enough about... that is something the neurosurgeon will know a lot more about. Worldwide every country has a different health system with more-less money. In some specialized plexus teams exist and I have been fortunate to be in this situation in Holland.I am afraid that treatment possiblities will differ per country.

We are always especially interested in elbow flexion as a first sign of nerve healing BUT the flexor carpi brachialis can flex the elbow as well. Pretty tricky to see which muscle is doing what. That is why working with a whole team is the preferable....or video-ing the session. Gives you time to look again afterwards.

good luck.... it is surely not easy

regards
Esther