CONGENITAL BRACHIAL PLEXUS
It is an important cause of neonatal morbidity that occurs as a result of damage to the brachial plexus during birth. Depending on the type of trauma, it may affect one or both extremities; It causes muscle atrophy, sensory loss, reflex loss, as well as a difference in length and thickness in the extremities.
CLINICAL TYPES OF BRACIAL PLEXUS LESIONS
UPPER PLEXUS LESION ( ERB-DUCHENNE PARALYSIS)
It is the most common type and has the best prognosis. It occurs due to damage to the C5 and C6 branches or the upper trunk. In ErbDuchenne paralysis, on the affected side, the shoulder is in internal rotation and adduction, the elbow is in full extension, the forearm is in pronation, the fingers and the wrist are in flexion.
MIDDLE PLEXUS LESION
C7 It is a single injury and is rare. Extrinsic wrist and finger extensors are affected as a result of C7 involvement.
LOWER TRUNCH LESION (KLUMPKE'S PARALYSIS)
It is the type that develops as a result of damage to C8-T1 or the lower trunk. It is rare in isolation and is usually accompanied by C7 injury. The prognosis is not good in this type of paralysis. In Klumpke's paralysis, the shoulder and elbow are fine, but the intrinsic and extrinsic hand muscles are involved. With C7 involvement, this is accompanied by paralysis in the hand and wrist extensors.
TOTAL PLEXUS LESION
It is the most serious injury in which all plexus roots are damaged. There is motor and sensory loss in the entire affected extremity.
BRACHIAL PLEXUS CONSERVATIVE TREATMENT
After the initial evaluation of the patient, the patient should be included in a conservative treatment program. Conservative treatment approaches; It can be classified as passive joint range of motion exercises (ROM), Vojta therapy, splinting, splinting, taping (kinesiotape), botulinum toxin injection and electrical stimulation.
The aim of conservative treatment is;
- Preserving the length of the soft tissue
- Stimulating limb mobility
- Minimizing unorganized movements of the limb
- Prevention of atrophy and contractures that may occur
- The length that may develop between the upper extremities and preventing or minimizing thickness differences
Increasing the functionality of the paralyzed extremity and ensuring its use to perform daily living activities.
In conservative treatment, it is very important to encourage the use of the extremity. In order to provide sensory awareness in the treatment, it will be useful to use other methods that will trigger sensory awareness and increase functionality, such as tactile stimulation, massage and occupational therapy, which start with soft materials and gradually work with harder materials.
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