Rehabilitation of brachial plexus paralysis

The article was consulted with Dr. Phan Dinh Thuy Tien - General Internal Medicine - Department of Medical Examination & Internal Medicine - Vinmec Nha Trang International General Hospital.

Injury to the brachial plexus is common in young people; Most of the causes are due to childbirth, difficult births, low birth weight, when the baby is born in the breech position, ... causing the child to have brachial plexus paralysis or suffer from paralysis. weakness in upper extremities (hands) gradually causing loss of sensation, limb deformity.

The brachial plexus is a network made up of the anterior branches of four cervical and one thoracic spinal nerves (C5, C6, C7, C8, T1). The plexus extends from the spinal cord, through the cervical canal - the armpit into the armpit. It feeds motor and sensory nerve fibers and innervates the chest, shoulders, arms, and hands.

The main cause of brachial plexus paralysis is that during childbirth, the baby is born in the breech position (ie, the buttocks are forward and the head is back), the mother is difficult, often has weakness in the muscles of the upper extremities and loss of sensation, followed by vaginal discharge. show sympathetic nerve changes, soft tissue contractures, and limb deformities.
In adults, the cause of brachial plexus paralysis is a traffic accident, an accident during daily life, or a stabbing weapon such as a knife or knife. In particular, according to statistics, patients with brachial plexus paralysis, the main cause in Vietnam is traffic accidents.

Brachial plexus palsy is divided into 2 degrees: complete paralysis and incomplete paralysis.
Incomplete paralysis: It is classified into many sub-classes clinically and usually divided into 2 common types: upper body paralysis and lower body paralysis. Incomplete paralysis means that one of the fibers of the brachial plexus is still active. Total paralysis is paralysis of the entire brachial plexus.

Brachial plexus paralysis most patients recover.
For newborns, the recovery period usually occurs mainly in the first weeks immediately after birth. Recovery is best in mild cases (only myelin damage, small nerve fibers). In more severe cases, it can leave sequelae for children such as hand weakness, muscle atrophy, even true paralysis.
Monitoring and evaluating the degree of paralysis and motor recovery in newborns is difficult, so the baby needs to be evaluated by a specialist in rehabilitation. In addition, it is possible to preliminary monitor the recovery of movement by monitoring the baby's ability to stretch, flex and stretch.

5.1 Rehabilitation Rehabilitation is the main treatment for brachial plexus paralysis today. Brachial plexus palsy is often uneven because some muscles are paralyzed and some muscles still function normally. Spasticity can occur in non-paralyzed muscles.
The doctor will guide to perform hand movements for the baby to help relieve muscle spasms. In the first few days after birth, it is necessary to fix the baby's hand on the body to reduce pain for the baby.
When the child is older, it is necessary to encourage the child to participate in games with flexibility, use of coordination between both hands such as swimming to maintain good function of the injured hand.
In addition, there are some other measures to treat brachial plexus paralysis such as transcutaneous electrical stimulation, acupuncture.
5.2 Surgery Surgery is also a method to help restore brachial plexus paralysis. Surgical measures to treat brachial plexus paralysis have been applied in some developed countries such as the US and Europe. The time of surgery for children is from the first 3-4 months after birth. However, in Vietnam, it has not yet been developed and implemented. Prognosis
Most patients with brachial plexus paralysis will recover on their own, but still have hand weakness and limited mobility. In severe cases such as a severed nerve, surgery is required, otherwise it will not be able to recover on its own.
Partial paralysis of brachial plexus, early surgery less than 6 months, good muscle function can fully recover. In the case of total paralysis, only partial function of elbow flexion and shoulder extension is restored, and the fingers can later be grasped. In this case, complete recovery is not expected. It is necessary to have regular check-ups so that the doctor can monitor the recovery of the brachial plexus.