The brachial plexus is a complex network of nerves that allows for muscle control of the shoulder, arm, elbow, wrist, hand and fingers. Click here to Buy Dihydrocodeine 30mg Tablets from NHS Heroes in the UK The nerves originate at different points of the upper spine and run across the shoulder area. When the brachial plexus is injured, the nerves become damaged and result in a host of problems, including loss of muscle control and paralysis.
Surgical interventions to treat brachial plexus injuries begin with a primary, exploratory surgery to determine the extent and type of injury. During primary surgery, the plexus is surgically exposed. Nerves are located and evaluated by electrical stimulation to find out if they are “firing” or transmitting signals to the muscles of the arm and if they remain attached to the spinal cord. If a neuroma, or scar tissue, is present, surgeons may opt to clear it away by performing a procedure called a neurolysis.
Common reconstructive procedures utilized by Dr. Shenaq include nerve grafting and nerve transfers. During these procedures, expendable nerves are taken from other areas of the body, such as the neck or legs. These sensory nerves are made into cable-like grafts at the end of the brachial plexus nerve that is injured, allowing it to renervate from its mother cells in the spinal cord.
The majority of brachial plexus injuries occur during birth, most often as a result of significant force applied to an infant’s head during delivery. Larger babies, whose shoulders tend to be wider, can have difficulty passing through the birth canal, and they are at higher risk of injury to the plexus.
More newborns suffer birth-related brachial plexus injuries than are born with Down syndrome or spina bifida. The injury affects as many as three of every 1,000 births.
Brachial plexus injuries also can affect older children and adults injured in sporting accidents; car, motorcycle or boating accidents; animal bites; and gunshot or puncture wounds. About one in 10 injuries are due to accidents and are not birth related.
Fortunately, about 75 percent to 80 percent of all birth-related brachial plexus injuries heal spontaneously with no surgical intervention. Because of this, many in the medical community back away from treating the injury early and allow it to heal on its own. However obstetrical brachial plexus injuries that have not healed within the first few months of life often benefit from interventional treatment.
The International Brachial Plexus Institute is one of a handful of facilities in the world dedicated to evaluating and treating brachial plexus injuries in children. Director and founder Dr. Saleh M. Shenaq, has seen more than 5,000 patients with brachial plexus injuries in his career. Additionally, he consults with pediatric orthopedic surgeons, pediatric psychiatrists and psychologists, occupational and physical therapists, child life specialists and social workers.
“Having a child with a brachial plexus injury can be an emotionally charged situation,” said Lisa Thompson, nurse coordinator for The Institute. “Parents want to do everything they can to help their child gain full use of the injured arm, so they come to the place that has the most expertise and the best track record. The majority of our families travel quite a way to have their children seen by Dr. Shenaq.”
When patients arrive at The International Brachial Plexus Institute, Dr. Shenaq evaluates the type of injury that has occurred and which nerves are involved. He listens to parents’ observations and gathers information about the child’s medical history and progress.
Treatment Options Explored
Depending on the type and severity of brachial plexus injury, Dr. Shenaq determines what treatments will best help the child and discusses options with the family. Many children improve with occupational or physical therapy, but many also benefit from a combination of surgery and therapy. Babies who show little or no improvement in the paralyzed muscle function within the first six months of life most likely will require surgical intervention.
The quad involves a group of very effective muscle releases and transfers that can put the arm in a more natural position and allow the patient to lift it over his or her head. The procedure is so named because it involves four components: the transfer of muscles to restore balance of the shoulder’s outward and upward movements; decompression of the axillary nerve; neurolysis for fuller movement of the deltoid muscle; release of the contracted muscles and torn capsule.
Depending on the individual child, other nerve decompressions or muscle and tendon transfers might be performed at the same time. This is known as a modified quad, or “mod-quad,” procedure. During the mod-quad surgery, muscles and tendons are rerouted to place them in better position for overall function.