Brachial Plexus

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Brachial Plexus is a plexus of nerve arising from the neck to supply the entire upper limb. Injury to this plexus results in paralysis of the upper limb.
The commonest cause of injury is usually an accident on a two-wheeler, however any type of accident that forcefully pulls or pushes the hand away from the neck can result in this kind of injury. Depending on the force and type of accident various grades of injury to the brachial plexus can happen. This results in a complete spectrum of paralysis of the upper limb from only partial weakness to a full paralysis involving shoulder, elbow and entire hand.
The treatment for a brachial plexus injury can be different according to the type of injury. The various procedure that may be involved are
  1. Neurolysis

Here the scar tissue around the nerve are released allows growth of nerve fibers

  1. Nerve Grafting

Here the gap in the damaged nerve are bridged by using nerve from another part of the body. These nerves are joined using microsurgical techniques.

3.Nerve transfer

Sometimes nerve which supply other less important muscles are borrowed to make the paralyzed muscles work. The nerve that are borrowed usually cause very little problem and help in important function like moving the elbow or shoulder.

 

  1. Muscle Transfer

In certain cases, it may be necessary to move a muscle from one function to perform another function. Usually, to move the shoulder or elbow. The transferred muscle or elbow have to undergo training during physiotherapy to learn how to perform the new task assigned to it. This process usually takes a few months of physiotherapy

5.Functional Muscle Transfer

In certain extreme cases it may be necessary to borrow an entire muscle along with its blood supply and nerve supply and bring it to the paralyzed arm, to perform a new job. Usually, a muscle from the thigh is transferred to the upper limb. These are complex microsurgical techniques and need a lot of rehabilitation efforts to make it useful.

 

6.OBPP

Obstetric Brachial Plexus Palsy is a term used to describe brachial plexus injury in new born. This is usually a sequela by a complicate delivery.

The children are noticed to have no movement or abnormal movement of the upper limb.

The treatment of these children is complex. The difficulty arises in deciding when to operate and not to operate.

The children have to be followed on a regular basis by their Plastic surgeon. Any deviation in the recoveree of the hand function may need a surgical procedure.

The treatment of children with OBPP may include

Neurolysis

Nerve transfer

Nerve grafting

Muscle transfer

FFMT’S

Botox

Bony correction

Muscle contract release etc.