Brachial Plexus is a large nerve group located in the armpit region, where the nerve roots originating from the spinal cord travel in three large branches and connect with each other. These nerves provide movement and sensation to the shoulder blade, shoulder and arm muscles. In case of injury, the shoulder blade, shoulder, elbow, wrist, hand and finger muscles may be affected. The muscles that do not work or are affected vary depending on the severity of the injury and the damaged parts of the nerve. Brachial plexus injuries often occur during birth and are called 'obstetric' brachial plexus injuries in medical terms. Apart from congenital causes; Injuries may also occur due to vascular problems such as trauma resulting from motorcycle and vehicle accidents, thoracic outlet syndrome, radiation, tumor spread, brachial neuritis and aneurysm causing compression.
Brachial Plexus is located in the trunk of the trunk in breech (breech) delivery. It can occur due to excessive bending of the neck to the side, or after the stretching applied to the nerves due to excessive bending of the head and neck during delivery in births from the head, and it can also occur in babies with a large birth weight, who are larger than the mother's hips, and whose heads are large. Findings such as the baby's inability to move both arms equally, color change and swelling in the affected arm, the baby's affected arm slipping while being picked up, difficulty in fixation, inability to make a fist with the affected hand, inability to grasp the finger when extended, unilateral swelling on the collarbone, indicate brachial plexus paralysis to families and pediatricians.
Improvement in patients in the first two weeks is a sign of good prognosis. Magnetic resonance (MRI) examination is the best imaging method for diagnosis. Electrodiagnostic examination provides information about the time, degree, prognosis and localization of the injury.
Treatment begins with exercise and physical therapy applications. In some children with brachial palsy, interventions such as electrical stimulation and botulinum toxin injection may help recovery. In paralyzed patients, both in infancy and adulthood, if there is no improvement within 3 months, surgical treatment is required.
In the surgical intervention on the nerves, the brachial plexus is created through incisions made in the neck and/or armpit. The sturating nerve bundles are reached. Broken nerves are repaired using microsurgical methods. Diseased nerve tissues that have scar tissue inside are removed and nerve repair is performed again. In order to repair irreparably injured nerves, it may be possible to transfer a neighboring nerve in the nerve bundle that forms the brachial plexus or to bring a less used nerve from another part of the body. In cases of paralysis that does not return with these treatments, it is possible to regain the lost movements by surgically transplanting the working muscles to replace the non-functioning ones (tendon transfer). Teamwork is very important in surgical cases. The rehabilitation program should continue after the surgery as it did before.
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