Brachial Plexus Injury and Physiotherapy

It varies according to the social development level of the country.

• In our country: It is between 0.19 - 2.5 per 1000 live births.

What Should Be Considered During the Acute Period of Brachial Plexus Injury?

• A resting position is recommended for the first 10 days after birth. . (unless there is a collarbone fracture or similar complications)

• Backward movement (retraction) of the shoulder should be prevented.

• 90˚ exceeding flexion, abduction; 45˚� Shoulder rotations exceeding 10 cm are not recommended.

• When dressing the baby, the injured side is dressed first. When removing it, this side is removed first.

• The joints should be moved within the limits of normal joint space.

Types of BP Injury?

According to the severity of injury;

• Mild

• Moderate

• Heavy

According to the affected part of the plexus;

• Erb Duchenne (C5 – C6)

• Klumpke (C8 – T1)

• Mixt tip (C5 – T1)

What Affects the Course of BPY?

• Suprascapular nerve injury

• Type of injury (avulsion, ischemia)

• Level of injury

• Presence of Horner syndrome

• Accompanying bone fractures

• Periscapular muscle involvement

• Phrenic nerve involvement

• According to a comprehensive study; Functional return in babies is 95% and 90% of this recovery occurs within the first 4 months.

What are the Signs and Symptoms of BPY?

Symptoms that may be seen in the first month:

• Position of the affected arm

• Every Inability to move both arms equally

• Decreased tone in the arm muscles, difficulty in fixing the arm

• Edema and/or discoloration in the arm above the collarbone change

• Difficult on the arm on the side of the lesion when dressing

1. Symptoms That May Be Seen After Months

• Inability to bring the hand to the mouth

• Always grasping objects and toys with one hand

• Does not extend the arm on the side of the lesion when lying face down

• Delayed development of sitting balance and tendency to fall on the side of the affected arm

What to Check for Early Diagnosis in BPY?

• Collarbone / humerus / rib fracture?

• On the lesion side; Less movement of head, neck and arm

• Tendency to turn the head towards the side of the lesion

• Horner's syndrome (especially total paralysis)

• Edema in the arm on the side of the lesion

• Asymmetric breathing / diaphragm elevation (n. phrenicus involvement)

• Radiological imaging

• EMG

What to Check for Differential Diagnosis of BPY?

• Humerus / clavicula fx.

• Humerus proximal epiphyseal separation

• Humerus OM

• Shoulder septic arthritis

• Cord tumors

• Cerebral paralysis

Treatment of Congenital Brachial Plexus Injury

• In cases that can be diagnosed immediately after birth, the arm may be damaged due to edema and possible bleeding in the nerve and surrounding tissues. -It is necessary to rest for 2 weeks. If there is a fracture or injury in the collarbone, care should be taken.

• In order to prevent tension on the nerve for the first 2 weeks, the arm should not be kept hanging, the arm should be kept slightly to the side and the elbow slightly bent. The device is not recommended during this period. In the old years, during this period, full fixation was performed with the arm 90 degrees to the side and facing outwards. Recent literature studies emphasize that a tight and rigid fixation can lead to stiffness in the shoulder and arm joints and shoulder dislocations.

• After 2 weeks, after a detailed physiotherapy evaluation. Exercise practices should be started.

 

WHAT ARE THE OBJECTIVES OF THE PHYSIOTHERAPY PROGRAM?

• Preventing muscle weakening and muscle disorders due to long-term inactivity,

• Maintaining joint opening and preventing stiffness,

• The baby's Preventing motor development delays,

• Ensuring functional use of the arm and hand

• Providing positions that will prevent shoulder dislocations and muscle injuries.

• Ensuring functional use of the arm and hand. p>

RECOMMENDATIONS ON BRACHIAL PLEXUS

 

• Exercises are designed for every child to be done regularly by families. D It is recommended after the change. Movements should be large enough to be done at every diaper change during the day. Positioning is as important as the movements to be applied to the arm muscles and joints.

• In this period, the arm should be prevented from sagging while holding the baby, changing clothes and washing it, lying on the back should be preferred in this period. During the exercise, the arm should be kept up and slightly to the side, with the elbow slightly bent. This position can be achieved by placing a thin and small pillow under the shoulder and arm and fixing the arm of the baby's bodysuit on the chest.

• When wearing the baby's clothes, the affected arm is first dressed and then removed. Clothes with narrow armholes, tight clothes, and clothes that are difficult to wear should be avoided.

 

PHYSICAL THERAPY IN BRACIAL PLEXUS

• Preserving joint range of motion and preventing limitations

• Preventing adduction and internal rotation contracture in the shoulder

• Prevention of posterior subluxation of the radius at the elbow (protrusion towards the back)

• Prevention of atrophy and muscle weakness

• Functional improvement of the upper extremity from the early period. usage

• Prevention of motor delays that may occur due to underuse of the upper extremity

• Suggestions for the family to remember the unused arm

• Lying in bed in a way that allows you to see the arm with nerve damage,

• How to carry it in your arms

Education should be given and therapy should be started early.

 

 

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