A brachial plexus birth injury is an injury to an infant’s brachial plexus nerves that occurs during childbirth, often when the baby’s neck is stretched to one side when being delivered vaginally. This can happen if the mother has a particularly long labor, if the baby is breech, or if the baby’s shoulders are too wide to fit through the birth canal. Because this network of nerves runs from the cervical spinal cord in the neck to the shoulder, arm and hand, an injury to one or more of these nerves can lead to upper extremity weakness or paralysis and numbness.
To treat these patients and restore function in their upper extremities, a team of researchers from Children’s Hospital of Philadelphia (CHOP) suggests a multidisciplinary approach that draws on multiple medical specialties. The research team recently described their model for care in The Journal of Bone and Joint Surgery.
“Management of brachial plexus birth injuries with a multidisciplinary team allows us to achieve the best outcomes for the patient while avoiding unnecessary interventions,” said Apurva S. Shah, MD, MBA, an orthopaedic surgeon with CHOP’s Brachial Plexus Injury Program. “The expertise of each member of the team, from neurologist to surgeon to physical therapist, is essential in treating this condition.”
In the case study of a five-month old infant treated at CHOP, the researchers discuss the important roles of specialists, including surgeons, neurologists, occupational and physical therapists, and radiologists. The patient, who has regained significantly upper extremity function, received coordinated care from all disciplines through serial examinations, medical interventions, and therapeutic interventions. The team was able to avoid shoulder surgery for this child by using a non-operative procedure that involved injection of botulinum toxin and casting, resulting in a similar outcome to surgery. As part of this broad approach, the multidisciplinary team will continue to follow the patient periodically throughout childhood to monitor his progress. The researchers suggest this sort of paradigm will lead to better outcomes for patients with this condition.