Materiały źródłowe

• #1 Brachial plexus injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/diagnosis-treatment/drc-20350241

  Treatment depends on many factors, such as the seriousness of the injury, the type of injury, the length of time since the injury and other existing conditions. […] Your healthcare team may suggest physical therapy to keep the joints and muscles working properly, maintain range of motion, and prevent stiff joints. […] Surgery is often the best option for serious nerve injuries. In the past, surgery was sometimes delayed to see if the nerves would heal on their own. However, new research shows that delaying surgery by more than 2 to 6 months could make the repair less successful. New imaging techniques can help your healthcare team decide when surgery would be most beneficial. […] Nerve tissue can be taken from other parts of the body to replace the damaged parts of the brachial plexus nerves.

• #1 Brachial Plexus Injury: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/22822-brachial-plexus-injury

  Mild brachial plexus injuries may heal without treatment, but more severe injuries may require surgery to regain function in your arm or hand. […] Many brachial plexus injuries will heal without surgery over a period of weeks to months, especially if they’re mild. Nerve injuries that heal on their own tend to have better outcomes in terms of muscle and nerve function. […] Healthcare providers typically recommend surgical treatment for brachial plexus injuries when the nerves don’t heal on their own or don’t recover enough to restore necessary function to your arm and hand. […] If your newborn has a mild brachial plexus injury, their provider will likely recommend gently massaging their arm and range-of-motion exercises for treatment. […] If the damage is severe or it doesn’t improve within the first few weeks, your baby may need to see a pediatric neurosurgeon. They may consider surgery if your baby’s strength doesn’t improve by 3 to 9 months of age.

• #1 Traumatic Brachial Plexopathy Treatment & Management: Rehabilitation Program, Medical Issues/Complications, Surgical Intervention

  https://emedicine.medscape.com/article/316888-treatment

  Occupational Therapy […] During occupational therapy efforts are concentrated on maintaining ROM in the shoulder; fabricating appropriate orthoses to support the function of the hand, elbow, and arm; and addressing edema control and sensory deficits, with testing and therapy. Occupational therapy may address issues related to the patient’s ability to write, type, and find alternate ways of communicating. Additionally, occupational therapy provides help with retraining for activities of daily living (ADLs), including the use of 1-arm techniques, adaptive equipment, and self-ranging and strengthening exercises. […] Surgical Intervention […] Surgery is reserved for patients in whom symptoms persist despite appropriate conservative treatment. Two important issues to consider before surgery are as follows: (1) whether function can be obtained after the nerve is repaired and (2) whether the potential benefit to the patient outweighs the surgical risks, costs, and loss of productivity. The timing of surgery is important as well. Other factors to consider are as follows: In clean lacerating injuries in which the nerve ends are visible in the wound or when clinical examination reveals obvious motor and sensory deficits from the laceration, immediate primary repair may be indicated. In blunt transections resulting from lacerations, delayed repair has a better surgical result. Injuries without evidence of early spontaneous recovery, such as those caused by bullets, crushing blows, traction, fractures, or injections, are explored several months after the injury. Brachial plexus stretches or contusions are observed for 4 months. If no evidence of recovery is present, the plexus is explored. Nerve or tendon transfers may be necessary if nerve repair is unsuccessful. Brachial plexus injuries are not always reparable. In such cases, neurotizations or nerve transfers may offer a better functional outcome. Surgical repairs are most effective within 3 months of the injury. Surgical delays in excess of 5 months dramatically decrease the rate of functional return. When repair does not provide adequate results, planned tendon transfers can increase extremity function. Rarely, in cases of a complete multilevel injury (eg, flail injury, anesthetic arm), amputation may result in a better functional outcome, because the patient can use the extremity with an appropriate prosthesis. However, the result may be less cosmetically pleasing than would that obtained with other approaches.

• #1 Brachial plexus injury – Wikipedia

  https://en.wikipedia.org/wiki/Brachial_plexus_injury

  Furthermore, in a systematic review it has been noted that physical therapy interventions in children is able to improve range of motion, muscle strength, bone mineral density, and shoulder function; this can help children regain some or all the function they initially lost. […] The exercises mentioned above can be done to help rehabilitate from mild cases of the injury. However, in more serious brachial plexus injuries surgical interventions can be used. Function can be restored by nerve repairs, nerve replacements, and surgery to remove tumors causing the injury. […] Physical and occupational therapy is important when dealing with a brachial plexus injuries. One of the main goals of rehabilitation is to prevent muscle atrophy until the nerves regain function. Electrical stimulation is an effective treatment to help patients reach this fundamental goal. Exercises that involve shoulder extension, flexion, elevation, depression, abduction and adduction facilitate healing by engaging the nerves in the damaged sites as well as improve muscle function. Stretching is done on a daily basis to improve or maintain range of motion. Stretching is important in order to rehabilitate since it increases the blood flow to the injury as well as facilitates nerves in functioning properly.

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• #1 Nonsurgical Treatment for Brachial Plexus Injuries | NYU Langone Health

  https://nyulangone.org/conditions/brachial-plexus-injuries/treatments/nonsurgical-treatment-for-brachial-plexus-injuries

  NYU Langone doctors determine the most effective treatment plan for brachial plexus injuries based on the type of injury and the severity of symptoms. […] Our doctors may recommend a combination of treatments to relieve pain, stabilize the injured area, and improve your range of motion and strength. For most people with brachial plexus injuries, physical and occupational therapy are key components of both treatment and recovery. […] Our doctors may recommend using a series of custom casts to treat the brachial plexus injury and improve range of motion and joint alignment by gradually stretching the joint. […] Once you can move comfortably, our orthopedic experts may recommend physical therapy to build strength lost from a brachial plexus injury. […] Occupational therapy may be recommended if your fine motor skills have been affected.

• #1 5 Exercises to Improve Arm Function After a Brachial Plexus Injury – Southern California Brain & Spine Surgery

  https://socalbrainspine.com/blog/5-exercises-to-improve-arm-function-after-a-brachial-plexus-injury/

  A brachial plexus injury can significantly impact arm function, affecting daily activities and quality of life. However, with proper rehabilitation and targeted exercises, its possible to improve arm strength, mobility, and overall function. This blog will explore five effective exercises designed to aid recovery from brachial plexus injuries. […] Rehabilitation exercises play a vital role in recovery, helping to maintain muscle tone, improve range of motion, and potentially restore function. […] These exercises are most effective when combined with other treatments such as physical therapy, occupational therapy, and potentially surgical interventions in severe cases. […] The five exercises outlined above shoulder shrugs, pendulum exercise, wrist flexion and extension, elbow flexion and extension, and finger exercises can form a solid foundation for your rehabilitation program. […] While these exercises can be beneficial, they should be part of a comprehensive treatment plan developed by healthcare professionals.

• #1 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  Occupational therapy is frequently utilized after brachial plexus injuries and is based on deliberate and targeted occupational exercises to enhance the patients capacity to adapt to daily life and expedite the patients return to family and society. […] The profession of occupational therapy for patients with brachial plexus injuries is not standardized. […] Neurotrophic treatment will be used continually and regularly. […] Numerous studies have demonstrated the effectiveness of early modalities in reducing swelling, promoting edema absorption, relieving pain, and releasing adhesions. […] Electrical nerve stimulation promotes nerve healing and regeneration and is a useful tool. […] The stimulation techniques mentioned above may need to rely on relatively unharmed nerve-down routes to effectively stimulate peripheral nerves, particularly in individuals with diminished fine hand function following brachial plexus injury.

• #1 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  The benefit of neuro-electromagnetic stimulation in the treatment of neuropathic pain, which may be regularly utilized in pain management, should not be overlooked. […] Acupuncture and tui na are widely used in traditional Chinese medicine to treat brachial plexus nerve injury. […] Emotional and social factors may influence rehabilitation after brachial plexus injury, particularly in a productive young male population. […] The best period for postoperative fixation is not universally agreed upon; however, it is crucial to hold off until the nerve anastomosis site is tension-free, particularly after repairing a nerve with significant local tension. […] Even with complete rehabilitation and satisfactory neurological recovery, associated complications, including pain, muscle atrophy, restricted joint mobility, and subsequent abnormalities, are still possible.

• #1 Brachial plexus injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/diagnosis-treatment/drc-20350241

  Nerve transfers are most helpful for serious brachial plexus injuries, called avulsions. An avulsion happens when the nerve root has been torn out of the spinal cord. Nerve transfers also may be used to speed up muscle recovery. […] If the arm muscles are weak from lack of use, a muscle transfer may be needed. […] Serious brachial plexus injuries can cause extreme pain. The pain has been described as a debilitating, severe, crushing feeling or a constant burning. This pain goes away within three years for most people. If medicine can’t control the pain, your healthcare team might suggest surgery to interrupt the pain signals coming from the damaged part of the spinal cord.

• #1 Surgical treatment of brachial plexus injuries – UpToDate

  https://www.uptodate.com/contents/surgical-treatment-of-brachial-plexus-injuries

  Surgical treatment of brachial plexus injuries […] Surgical management of brachial plexus injuries requires a multidisciplinary approach including physical medicine and rehabilitation, physical and occupational therapists, neurologists/neurophysiologists, and a reconstructive surgeon with expertise in peripheral nerve surgery. […] The approach to the surgical treatment of brachial plexus injury, including preoperative evaluation, approach to repair, and techniques, is reviewed here. […] Techniques for managing traumatic injuries include nerve decompression, nerve reconstruction, nerve transfers, free functional muscle transfers, tendon transfers, joint fusion, and targeted muscle reinnervation and bionic reconstruction. […] Postoperative care and rehabilitation are essential for achieving functional outcomes.

• #1 Brachial Plexus Injuries – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/brachial-plexus-injuries/

  During your discussion with your doctor, it will be important to set realistic goals and expectations for surgical treatment. Nerves heal slowly. The recovery period after surgery is often long and requires a strong commitment to a comprehensive rehabilitation program to restore physical abilities. […] Several surgical techniques are used to treat nerve injury, depending on the type of injury and the length of time that has passed since the injury. […] In most procedures, the surgeon makes an incision near the neck above the collarbone. If the injury extends down the brachial plexus, the surgeon may need to make another incision at the front of the shoulder. […] Nerve repair is typically performed immediately for sharp lacerations to the nerves, such as from a knife wound. […] Nerve grafting is a procedure in which a healthy nerve taken from another part of the body is sewn in between the two ends of a ruptured nerve.

• #1 Brachial Plexus Injury Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/brachial-plexus-injury

  Injury to the brachial plexus can reduce or destroy sensation or movement in the arm or hand. At the Peripheral Nerve Center at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, we treat brachial plexus injuries with procedures that include nerve repair, nerve graft and nerve transfer. […] Most people who are candidates for surgery have experienced severe nerve injuries called avulsions, ruptures, and lacerations. […] Though this is the most difficult type of peripheral nerve injury to treat, we perform several surgical techniques that may permit the recovery of useful function even after an avulsion. […] A nerve transfer can help when a nerve has been severely damaged. In this procedure, a healthy nerve is taken from its original location and inserted into a different location where the nerve supply has been damaged.

• #1 Brachial Plexus Injuries – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/brachial-plexus-injuries/

  A nerve transfer procedure is used when there are no functioning nerve stumps in the neck to which nerve grafts can be connected. […] Patients who delay that first visit to the doctor for more than 12 months after injury tend to have poor outcomes with surgery to reconstruct or repair nerves. These patients are managed better with surgery that focuses on reconstructing the tendon (tendon transfer) or muscle (free-functioning muscle transfer). […] Because nerve regeneration occurs slowly at a rate of approximately 1 mm/day, recovery from a brachial plexus injury takes time, and patients may not experience results for several months. A positive mindset and the support of family, friends, and healthcare professionals are important to recovery and rehabilitation. […] Although brachial plexus injuries can be devastating and difficult to manage, a team approach to treatment has made significant improvements in patient function.

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  https://www.orthobullets.com/trauma/1008/brachial-plexus-injuries

  Brachial plexus injuries (BPIs) can involve any degree of injury at any level of the plexus and range from obstetric injuries to traumatic avulsions. […] Treatment can be conservative versus operative depending on the age of patient, chronicity of injury, degree of injury and nerve root involvement. […] Nonoperative observation alone waiting for recovery indications most managed with closed observation. […] Operative immediate surgical exploration (1 week) indications sharp penetrating trauma (excluding GSWs). […] early surgical intervention (3-6 weeks) indicated for near total plexus involvement and with high mechanism of energy. […] delayed surgical intervention (3-6 months) indications partial upper plexus involvement and low energy mechanism. […] Direct nerve repair rarely possible due to traction and usually only possible for acute and sharp penetration injuries.

• #1 Brachial Plexus Injury | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/b/brachial-plexus

  Nonsurgical management is also an important part of the treatment process. […] Occupational and / or physical therapy is often recommended, including range of motion, strengthening, neuromuscular electrical simulation, kinesio taping, constraint-Induced Movement Therapy (CIMT), serial casting, aquatic therapy and use of orthoses, as needed. […] The timeframe of surgical repair is an important factor in recovery. Within 18 months, the muscles that have not already connected to nerves may have weakened to the point where it is no longer possible. […] For avulsion and rupture injuries, there is no potential for full recovery unless surgical repair is done in a timely manner. […] If surgery is needed, microsurgical nerve repair may be undertaken as early as three months post injury. […] Primary nerve repair is typically completed by approximately six months of age following the injury.

• #1 Treatment of Brachial Plexus Injuries | BC Children’s Hospital Research Institute

  https://www.bcchr.ca/brachial-plexus/families/treatment

  Physiotherapy should begin early in the infant who has a brachial plexus injury. Therapy cannot heal the nerves faster but will help prevent further problems like development delay and joint stiffness and help strengthen the recovering muscles. Your child’s physiotherapist will design a treatment plan that is specific for your child. […] It is important to encourage active use of the child’s affected arm and hand. […] If your child has tight joints that may be difficult to help stretch, a splint (positioning support) may be recommended. These splints are usually custom made, specifically for your child and their needs by an occupational therapist. […] Nerve surgery: In some cases, surgical exploration of the nerves is required to improve the function of the arm. This is usually done in the first year of life.

• #1 Brachial Plexus Birth Injury Treatment | Best Treatment Options

  https://www.cerebralpalsyguidance.com/birth-injury/brachial-plexus/treatment/

  Other types of surgeries may help children with brachial plexus injuries recover more movement or sensation. These may include muscle or tendon transfers. […] Another treatment option for brachial plexus injuries is an injection of botulinum toxin A, also known as Botox. […] Recent research focused on creating the right conditions for nerve restoration after a brachial plexus injury. […] Typically, the most important treatments occur at an early age. […] The outlook for a brachial plexus injury is usually good. Most babies will recover and have no or only mild disabilities. The best way to improve the prognosis for your baby is to get treatment as soon as possible.

• #1 Brachial plexus injury – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/care-at-mayo-clinic/mac-20350243

  People with brachial plexus injuries usually see three surgeons during one office visit at Mayo Clinic. […] At Mayo Clinic, neurosurgeons, orthopedic surgeons, hand and microvascular surgeons, physical rehabilitation experts, and other specialists collaborate as a team to evaluate and treat each patient. […] This means that you’re not just getting one opinion you benefit from the knowledge and experience of each specialist on the multidisciplinary team. […] Surgeons, radiologists, physical therapists and other specialists collaborate as a team to evaluate your condition and choose the best treatment. […] At Mayo Clinic’s campuses in Minnesota, Arizona and Florida, neurosurgeons and orthopedic surgeons work together to perform needed surgeries at the same time. […] This can shorten the length of time you need to be under anesthesia.

• #1 Brachial plexus injury – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/care-at-mayo-clinic/mac-20350243

  Once you have suffered an injury of your brachial plexus, it is very important that you receive care for that injury in a timely fashion. […] This is a time sensitive injury and you should be evaluated by somebody who specializes in this field as soon as possible. […] Here at the Mayo Clinic in Arizona, we believe that patients with brachial plexus injuries deserve and require a team-based approach. […] That is why we have assembled a team to help address the needs of the entire patient. […] Here in the treatment of brachial plexus injuries we offer cutting edge procedures, including nerve transfers and muscle transplantations. […] Each treatment plan is individualized, taking into account the patient’s need such as degree of injury and type of reconstruction required. […] If you or a loved one has sustained a brachial plexus injury, we encourage you to seek out a brachial plexus specialist as soon as possible.

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  https://www.orthobullets.com/trauma/1008/brachial-plexus-injuries

  Nerve graft commonly used due to traction injuries (postganglionic). […] Neurotization (nerve transfer) transfer working but less important motor nerve to a nonfunctioning more important denervated muscle. […] Muscle or tendon transfer indications isolated C8-T1 injury in adult (reinervation unlikely due to distance between injury site and hand intrinsic muscles). […] Recovery of reconstructed plexus can take up to 3 years nerve regeneration occurs at speed of 1mm/day. […] Good prognostic variables infraclavicular plexus injuries have better prognosis than supraclavicular injuries. […] Poor prognostic variables root avulsion (preganglionic injuries) have worst prognosis not repairable.

• #1 Traumatic Brachial Plexus Injuries Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1268993-treatment

  The age of the patient is also an important consideration. The ability of nerve transfers to restore functional strength decreases dramatically with patient age. Therefore, many of the surgical options are reserved for younger patients. […] Advances in the field are likely to create more surgical options in the future. For example, Carlstedt obtained promising initial results with the repair of preganglionic lesions by replanting nerve rootlets directly into the spinal cord. This was a dramatic advance because preganglionic lesions were previously thought to be irreparable. […] Expectations after surgery are not for immediate recovery but, instead, for a slow process requiring significant patient and family education and involvement. Physical therapy is critical for safely maintaining joint motion and suppleness, in conjunction with supports for protection.

• #1 Traumatic Brachial Plexus Injuries Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1268993-treatment

  Nonoperative treatment of brachial plexus lesions is complex and may best be addressed by an integrated multidisciplinary team that includes a skilled orthotist, occupational therapists, physical therapists, and physicians. Bracing often plays a role in preventing contractures while one is waiting for recovery after surgery or waiting for recovery from neurapraxia. […] There have been reports in the literature assessing cellular therapy as a potential therapeutic modality after traumatic brachial plexus injuries, suggesting augmented clinical benefits with the combination of cellular therapy and rehabilitation. […] Surgical options include nerve (primary) and soft-tissue (secondary) procedures. Primary procedures are reparative in nature; secondary procedures are reconstructive. […] The three crucial factors in restoration of upper-arm function after brachial plexus injury are as follows: patient selection, timing of surgery, prioritization of restoration.

• #1 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  The purpose of this article is to explore the potential contributions of various methods to brachial plexus injury rehabilitation and to provide a concise overview of the interventions that have been shown to be beneficial. […] The key contribution of this article is to form relatively clear rehabilitation processes based on different periods and populations, which provides an important reference for the treatment of brachial plexus injuries. […] The management of BPI depends on the type, location, and severity of the injury. […] Rehabilitation, including neurotrophic therapy, is the best course of action before surgery. […] Following surgery, rehabilitation treatment can aid in the restoration of neurological function. […] Promoting nerve regeneration and functional recovery while safeguarding and regaining function in joints and intact muscles is the main objective of brachial plexus injury rehabilitation.

• #1 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  The basic stage in diagnosing NBPP is clinical evaluation and physical examination by an expert doctor. […] The fundamental rehabilitation strategies advised are parallel to those for adults, which include treatments such as passive/active motor exercises, smooth joint motor, sensory stimulation, electrical stimulation, and botulinum toxin injections. […] The agreement on a comprehensive rehabilitation process for NBPP continues to be in the early stages of development. […] The efficacy of comprehensive rehabilitation therapy is well established. […] In summary, we strongly advised that future research focus on the efficiency of potential comprehensive rehabilitation programs in the management of BPI, which will facilitate the return of patients, physical activity levels.

• #1 Brachial plexus injury – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/care-at-mayo-clinic/mac-20350243

  This constant, enthusiastic search for better ways to repair nerves, muscles and tendons has made brachial plexus treatment more reliable and consistent for patients at Mayo Clinic. […] Brachial plexus surgeons at Mayo Clinic have an extensive depth and breadth of experience with advanced microsurgical techniques. […] They have developed new muscle and tendon transfers and are at the forefront in understanding nerve regeneration. […] Mayo Clinic brachial plexus surgeons are recognized for their excellence and innovation.

• #2 Brachial Plexus Injury: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/22822-brachial-plexus-injury

  Mild brachial plexus injuries may heal without treatment, but more severe injuries may require surgery to regain function in your arm or hand. […] Many brachial plexus injuries will heal without surgery over a period of weeks to months, especially if they’re mild. Nerve injuries that heal on their own tend to have better outcomes in terms of muscle and nerve function. […] Healthcare providers typically recommend surgical treatment for brachial plexus injuries when the nerves don’t heal on their own or don’t recover enough to restore necessary function to your arm and hand. […] If your newborn has a mild brachial plexus injury, their provider will likely recommend gently massaging their arm and range-of-motion exercises for treatment. […] If the damage is severe or it doesn’t improve within the first few weeks, your baby may need to see a pediatric neurosurgeon. They may consider surgery if your baby’s strength doesn’t improve by 3 to 9 months of age.

• #2 Brachial plexus injury – Wikipedia

  https://en.wikipedia.org/wiki/Brachial_plexus_injury

  Treatment for brachial plexus injuries includes orthosis/splinting, occupational or physical therapy and, in some cases, surgery. Some brachial plexus injuries may heal without treatment. Many infants improve or recover within 6 months, but those that do not, have a very poor outlook and will need further surgery to try to compensate for the nerve deficits. […] The ability to bend the elbow (biceps function) by the third month of life is considered an indicator of probable recovery, with additional upward movement of the wrist, as well as straightening of thumb and fingers an even stronger indicator of excellent spontaneous improvement. Gentle range of motion exercises performed by parents, accompanied by repeated examinations by a physician, may be all that is necessary for patients with strong indicators of recovery.

• #2 Traumatic Brachial Plexopathy Treatment & Management: Rehabilitation Program, Medical Issues/Complications, Surgical Intervention

  https://emedicine.medscape.com/article/316888-treatment

  Rehabilitation Program […] Physical Therapy […] Depending on local expertise, a rehabilitation program may be undertaken with a physical therapist and/or an occupational therapist. The goals are to preserve ROM, improve strength, and manage pain. Patients should undergo physical therapy to maintain ROM and to optimize the recovery of motor function as muscle reinnervation occurs. The goal of treatment is to return function to the structures supplied by the damaged nerves and to improve the patient’s quality of life. The injured nerve and the exogenous sources of nerve injury are treated. At the onset of injury, early mobilization and icing are used. In the subacute phase, therapy gradually progresses from passive to active motion and from assisted to active ROM, as tolerated. Heat, ultrasonography, transcutaneous electrical nerve stimulation (TENS), interferential current stimulation, and/or electrical stimulation are used, depending on the predominant symptoms. Cervical muscle strengthening and the correction of upper extremity muscle imbalances are included in the protocol as well. The use of appropriate slings, the protection of extremities and joints, and the prevention of subluxation must be considered. Cervical pillows or collars may be required for patients with combined lesions of the roots and plexus. A literature review by de Santana Chagas et al found that in adults with brachial plexus injury, physical therapy most often involved kinesiotherapy (such as ROM exercises, muscle stretching, and strengthening techniques), electrothermal treatment, phototherapy, manual therapy, and sensory reeducation.

• #2 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  Occupational therapy is frequently utilized after brachial plexus injuries and is based on deliberate and targeted occupational exercises to enhance the patients capacity to adapt to daily life and expedite the patients return to family and society. […] The profession of occupational therapy for patients with brachial plexus injuries is not standardized. […] Neurotrophic treatment will be used continually and regularly. […] Numerous studies have demonstrated the effectiveness of early modalities in reducing swelling, promoting edema absorption, relieving pain, and releasing adhesions. […] Electrical nerve stimulation promotes nerve healing and regeneration and is a useful tool. […] The stimulation techniques mentioned above may need to rely on relatively unharmed nerve-down routes to effectively stimulate peripheral nerves, particularly in individuals with diminished fine hand function following brachial plexus injury.

• #2 Brachial Plexus Injury | Living With Paralysis | Reeve Foundation

  https://www.christopherreeve.org/todays-care/living-with-paralysis/health/causes-of-paralysis/brachial-plexus-injury/

  Level of treatment depends on the severity of injury. Brachial plexus injuries from mildly overstretched nerves are often treated conservatively. Injuries where the nerve is torn especially with rupture, neuroma (tumor), and avulsion requires surgery. Severely overstretched brachial plexus injuries can also require surgical intervention. […] Conservative treatments include: Physical therapy for arm mobility and strength, electrical stimulation, muscle stretches, range of motion and balance. Occupational therapy to learn techniques for activities of daily living and to obtain devices to improve independence such as use of button hooks and zipper pulls. Medications may be used such as steroid creams or injections to reduce inflammation and for pain control. Shoulder supports, splints, and/or compression garments may be used to support the limb, increase function without further injury to the nerve(s) and to control pain. Electrical stimulation may be gently supplied by electrodes placed on the skin to stimulate healing and control pain.

• #2 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  The purpose of this article is to explore the potential contributions of various methods to brachial plexus injury rehabilitation and to provide a concise overview of the interventions that have been shown to be beneficial. […] The key contribution of this article is to form relatively clear rehabilitation processes based on different periods and populations, which provides an important reference for the treatment of brachial plexus injuries. […] The management of BPI depends on the type, location, and severity of the injury. […] Rehabilitation, including neurotrophic therapy, is the best course of action before surgery. […] Following surgery, rehabilitation treatment can aid in the restoration of neurological function. […] Promoting nerve regeneration and functional recovery while safeguarding and regaining function in joints and intact muscles is the main objective of brachial plexus injury rehabilitation.

• #2 Guide | Physical Therapy Guide to Infant Brachial Plexus Injury (Erb’s Palsy, Klumpke’s Palsy) | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-infant-brachial-plexus-injury-erbs-palsy-klumpkes

  Physical therapists treat infants and children with brachial plexus injury to prevent arm tightness and promote function. […] A physical therapist is an important treatment partner for the family of any child with a brachial plexus injury. Physical therapy should begin as soon as possible after diagnosis or surgery and before joint or muscle tightness develops. Physical therapists can help prevent later problems as your child grows. […] Your physical therapist will work with your child to: prevent or reduce arm tightness, maintain or improve muscle strength, and aid in nerve repair and regrowth. […] Physical therapy will help your child after surgery by stretching and strengthening the arm and helping them return to activity. […] When a brachial plexus injury occurs, physical therapists can help prevent later problems as a child grows. Stretches are used to keep the arm from getting tight.

• #2 Physical therapy treatment brachial plexus injury – Direct Orthopedic Therapy

  https://directorthopedictherapy.com/physical-therapy-treatment-brachial-plexus-injury/

  Physical therapy can assist persons with milder brachial plexus injuries and those who have undergone surgery to repair a nerve in the brachial plexus. […] However, people in this situation will need extensive physiotherapy treatment to regain their ability to carry out their daily activities. […] Brachial plexus injury treatment includes: […] Keeping afflicted areas mobile by passive and active range of motion. […] Strengthening and regaining muscle mass through physical activity. Strengthening the body to keep up with the demands of daily life is another crucial goal. Strength will also assist in the prevention of future upper limb injuries. […] Calm the nerve system and alleviate pain by using acupuncture methods. […] Pain, limited motion, edema, tightness, and exhaustion are all symptoms that can be managed during recuperation.

• #2 Treatment | Birth Injury – Midwest Brachial Plexus Network

  https://birthinjury.org/introduction-brachial-plexus/treatment/

  These therapies are helpful in strengthening your child’s muscles, reducing atrophy, improving range of motion, and reducing scar tissue formation that causes contractures in muscles and around joints. […] Your occupational or physical therapist will give you exercises that are to be done at home. […] The importance of strictly following the home therapy program cannot be over-emphasized. […] In small doses it is used for medical purposes. Children with brachial plexus injuries may be given small doses of Botox to partially paralyze or weaken uninjured muscles around joints, in order to give the weaker muscles a chance to become stronger and more functional. […] Aquatic therapy is just what it sounds likeexercise that is performed in water. […] Whether aquatic therapy will provide any benefit at all for your child’s particular condition, or whether it should be in conjunction with land-based exercise programs, is something only you, in consultation with your child’s physician(s) can decide. […] A brachial plexus injury is not the end of the world, though there will certainly be times that your child and you are going to feel that way, especially when it comes to physical activities.

• #2 Traumatic Brachial Plexopathy Treatment & Management: Rehabilitation Program, Medical Issues/Complications, Surgical Intervention

  https://emedicine.medscape.com/article/316888-treatment

  Occupational Therapy […] During occupational therapy efforts are concentrated on maintaining ROM in the shoulder; fabricating appropriate orthoses to support the function of the hand, elbow, and arm; and addressing edema control and sensory deficits, with testing and therapy. Occupational therapy may address issues related to the patient’s ability to write, type, and find alternate ways of communicating. Additionally, occupational therapy provides help with retraining for activities of daily living (ADLs), including the use of 1-arm techniques, adaptive equipment, and self-ranging and strengthening exercises. […] Surgical Intervention […] Surgery is reserved for patients in whom symptoms persist despite appropriate conservative treatment. Two important issues to consider before surgery are as follows: (1) whether function can be obtained after the nerve is repaired and (2) whether the potential benefit to the patient outweighs the surgical risks, costs, and loss of productivity. The timing of surgery is important as well. Other factors to consider are as follows: In clean lacerating injuries in which the nerve ends are visible in the wound or when clinical examination reveals obvious motor and sensory deficits from the laceration, immediate primary repair may be indicated. In blunt transections resulting from lacerations, delayed repair has a better surgical result. Injuries without evidence of early spontaneous recovery, such as those caused by bullets, crushing blows, traction, fractures, or injections, are explored several months after the injury. Brachial plexus stretches or contusions are observed for 4 months. If no evidence of recovery is present, the plexus is explored. Nerve or tendon transfers may be necessary if nerve repair is unsuccessful. Brachial plexus injuries are not always reparable. In such cases, neurotizations or nerve transfers may offer a better functional outcome. Surgical repairs are most effective within 3 months of the injury. Surgical delays in excess of 5 months dramatically decrease the rate of functional return. When repair does not provide adequate results, planned tendon transfers can increase extremity function. Rarely, in cases of a complete multilevel injury (eg, flail injury, anesthetic arm), amputation may result in a better functional outcome, because the patient can use the extremity with an appropriate prosthesis. However, the result may be less cosmetically pleasing than would that obtained with other approaches.

• #2 Brachial plexus injury – Wikipedia

  https://en.wikipedia.org/wiki/Brachial_plexus_injury

  Furthermore, in a systematic review it has been noted that physical therapy interventions in children is able to improve range of motion, muscle strength, bone mineral density, and shoulder function; this can help children regain some or all the function they initially lost. […] The exercises mentioned above can be done to help rehabilitate from mild cases of the injury. However, in more serious brachial plexus injuries surgical interventions can be used. Function can be restored by nerve repairs, nerve replacements, and surgery to remove tumors causing the injury. […] Physical and occupational therapy is important when dealing with a brachial plexus injuries. One of the main goals of rehabilitation is to prevent muscle atrophy until the nerves regain function. Electrical stimulation is an effective treatment to help patients reach this fundamental goal. Exercises that involve shoulder extension, flexion, elevation, depression, abduction and adduction facilitate healing by engaging the nerves in the damaged sites as well as improve muscle function. Stretching is done on a daily basis to improve or maintain range of motion. Stretching is important in order to rehabilitate since it increases the blood flow to the injury as well as facilitates nerves in functioning properly.

• #2 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  The basic objectives of the spontaneous recovery period following brachial plexus injury are to ensure adequate muscle nutrition, preserve muscle function, and promote nerve regeneration until the nerve reaches the periphery because it takes a long time for nerves to reinnervate. […] Pain is present at all stages of brachial plexus injury, including acute neuromuscular injury pain, postoperative pain in the operative area, and chronic neuropathic pain, and it significantly reduces patients rehabilitation compliance, mental health, and quality of life. […] The various types of pharmaceuticals listed in the overview of pain management after complicated nerve injury can be used by both surgical and non-surgical patients. […] Neurostimulation has become increasingly effective for chronic neuropathic pain in recent years, in addition to surgical treatments such as nerve transfer and neuroma excision.

• #2 Treatment Options for Brachial Plexus Injuries

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4045367/

  The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed. […] Developments in microsurgery now offer us new modalities to improve the clinical outcome of brachial plexus lesions. The last 30 years have seen good progression in brachial plexus injury outcomes. Apart from nonoperative (conservative) management, through which we can achieve reasonable mobility with the help of rehabilitation and physiotherapy, we also have new surgical options, such as neurolysis, nerve repair, use of nerve grafts and nerve transfer, and palliative surgical procedures to obtain the best functional results, such as tendon transfer or functioning free muscle transplantation and arthrodesis.

• #2 Treatment Options for Brachial Plexus Injuries

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4045367/

  The aim of conservative treatment is to maintain the range of motion of the extremity, to strengthen the remaining functional muscles, to protect the denervated dermatomes, and to manage pain. […] A variety of surgical procedures have been reported to improve the functional outcome. Which one is appropriate depends on the type of lesion. The types of surgical procedures are as follows. […] Nerve grafting is the predominant technique for clear cut injuries with a healthy proximal stump and with no axial damage. […] Neurofibres are transferred to an irreparable paralytic. Motor branches are used as donors aiming to achieve motor reinnervation, respectively, to the sensory ones. […] In the absence of spontaneous recovery or when the first surgical procedure does not provide satisfactory outcomes then a second operation may be required.

• #2 Mass General Brigham Brachial Plexus & Nerve Disorders Program

  https://www.massgeneral.org/orthopaedics/brachial-plexus

  Surgical treatment options for brachial plexus injury include: […] Brachial plexus neurolysis is a surgery to explore the nerves of the brachial plexus, rid them from any external compression, and free them from surrounding scar tissue. […] Joint fusion surgery treats arthritic, unstable or flail joints by fusing two bones into one. […] Tendon transfer surgery connects a healthy, expendable muscle or tendon to a nonfunctional muscle or tendon. […] Nerve grafting surgery replaces an injured nerve with a healthy one, implanted from another part of the body through microsurgery. […] Nerve transfer surgery connects a healthy, expendable donor nerve to an injured nerve through microsurgery.

• #2 Brachial Plexus Treatment | Oklahoma Children’s Hospital OU Health

  https://www.ouhealth.com/oklahoma-childrens-hospital/childrens-services/neurosciences-for-children/brachial-plexus-treatment-for-children/

  When you choose Oklahoma Childrens Hospital for brachial plexus injury treatment, you and your child work with a multidisciplinary team of experts with the extensive training, experience and skill necessary to repair damaged nerves and restore function. […] Therapy helps maximize the use of the injured arm and prevents secondary issues like muscle atrophy or joint stiffness. Physical therapy and occupational therapy may be prescribed as a solo treatment or combined with surgery. […] Surgical techniques are appropriate for primary repair of these injuries in infants and secondary repair in older children. You and your childs doctor will discuss the specifics of your childs situation and determine the best possible surgical procedure to correct nerve damage, which may include procedures such as:

• #2 Brachial Plexus Injury | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/b/brachial-plexus

  Procedures include: […] Removal of the constrictive scar tissue surrounding the nerve. […] When the neuroma (scar tissue) is large, it must be removed and the nerve is then reattached either with end-to-end techniques or with nerve grafts. […] When the gap between the nerve endings is so large that it is not possible to have a tension-free repair using the end-to-end technique, nerve grafting is used. […] This is used generally in those cases where there is an avulsion. Donor nerves are used for the repair. […] Isolated transfer may be completed up to 12-18 months of age. […] A nearby healthy nerve is attached to the damaged nerve, closer to the target muscle. […] Additional procedures are available to improve the overall function of the affected limb.

• #2 Brachial Plexus Injury Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/brachial-plexus-injury

  Two common nerve transfers performed to restore shoulder abduction are the accessory-to-suprascapular nerve transfer and the triceps branch-to-axillary nerve transfer. […] Another surgical option for treating brachial plexus injury is the nerve graft. This procedure can be useful when it is necessary to bridge a gap between two cut ends of a nerve. […] A muscle transfer may be useful for some types of brachial plexus injuries. […] The Peripheral Nerve Center team is experienced with these and other procedures for treating brachial plexus injury, and they can determine the best treatment or combination of treatments for each individual.

• #2 Treatment Options for Brachial Plexus Injuries

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4045367/

  Arthrodesis resulting in shoulder stabilization gives the surgeon the opportunity to collect all potential nerve grafts so as to proceed with any available procedure. […] Tendon transfers are useful in restoring upper extremity function after BPI. […] Functioning free muscle transplantation (FFMT) is the transfer of a muscle using microvascular anastomoses for revascularization and subsequent microneural coaptation to the recipient motor nerve for reinnervation. […] However despite improvement in surgical techniques, even when these lead to an improvement in final outcome, the functionality of the upper limb is often disappointing.

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  https://www.orthobullets.com/trauma/1008/brachial-plexus-injuries

  Nerve graft commonly used due to traction injuries (postganglionic). […] Neurotization (nerve transfer) transfer working but less important motor nerve to a nonfunctioning more important denervated muscle. […] Muscle or tendon transfer indications isolated C8-T1 injury in adult (reinervation unlikely due to distance between injury site and hand intrinsic muscles). […] Recovery of reconstructed plexus can take up to 3 years nerve regeneration occurs at speed of 1mm/day. […] Good prognostic variables infraclavicular plexus injuries have better prognosis than supraclavicular injuries. […] Poor prognostic variables root avulsion (preganglionic injuries) have worst prognosis not repairable.

• #2 Brachial Plexus Injuries – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/brachial-plexus-injuries/

  During your discussion with your doctor, it will be important to set realistic goals and expectations for surgical treatment. Nerves heal slowly. The recovery period after surgery is often long and requires a strong commitment to a comprehensive rehabilitation program to restore physical abilities. […] Several surgical techniques are used to treat nerve injury, depending on the type of injury and the length of time that has passed since the injury. […] In most procedures, the surgeon makes an incision near the neck above the collarbone. If the injury extends down the brachial plexus, the surgeon may need to make another incision at the front of the shoulder. […] Nerve repair is typically performed immediately for sharp lacerations to the nerves, such as from a knife wound. […] Nerve grafting is a procedure in which a healthy nerve taken from another part of the body is sewn in between the two ends of a ruptured nerve.

• #2 Traumatic Brachial Plexus Injuries Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1268993-treatment

  Nonoperative treatment of brachial plexus lesions is complex and may best be addressed by an integrated multidisciplinary team that includes a skilled orthotist, occupational therapists, physical therapists, and physicians. Bracing often plays a role in preventing contractures while one is waiting for recovery after surgery or waiting for recovery from neurapraxia. […] There have been reports in the literature assessing cellular therapy as a potential therapeutic modality after traumatic brachial plexus injuries, suggesting augmented clinical benefits with the combination of cellular therapy and rehabilitation. […] Surgical options include nerve (primary) and soft-tissue (secondary) procedures. Primary procedures are reparative in nature; secondary procedures are reconstructive. […] The three crucial factors in restoration of upper-arm function after brachial plexus injury are as follows: patient selection, timing of surgery, prioritization of restoration.

• #2 Traumatic Brachial Plexus Injuries Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1268993-treatment

  The age of the patient is also an important consideration. The ability of nerve transfers to restore functional strength decreases dramatically with patient age. Therefore, many of the surgical options are reserved for younger patients. […] Advances in the field are likely to create more surgical options in the future. For example, Carlstedt obtained promising initial results with the repair of preganglionic lesions by replanting nerve rootlets directly into the spinal cord. This was a dramatic advance because preganglionic lesions were previously thought to be irreparable. […] Expectations after surgery are not for immediate recovery but, instead, for a slow process requiring significant patient and family education and involvement. Physical therapy is critical for safely maintaining joint motion and suppleness, in conjunction with supports for protection.

• #2 Brachial Plexus Injury Program | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/brachial-plexus-program/

  Our occupational therapists will begin therapy, including range of motion and activities to develop awareness of the involved side, and promote alignment of the head, trunk and arm. […] Our specialists often use non-surgical treatments and therapies to stimulate, stretch and strengthen your child’s affected arm. […] The vast majority of children with birth-related brachial plexus injuries recover without surgery. […] If your child does not recover well by age 3 or 4 months, our specialists will consider surgery in the first year of life. […] The goal of surgery is returning function and feeling to your child’s arm. […] Following surgery and early therapies, most children who have had a brachial plexus injury continue to need therapy on an outpatient basis and at home.

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• #2 Brachial Plexus Injury | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/b/brachial-plexus

  Nonsurgical management is also an important part of the treatment process. […] Occupational and / or physical therapy is often recommended, including range of motion, strengthening, neuromuscular electrical simulation, kinesio taping, constraint-Induced Movement Therapy (CIMT), serial casting, aquatic therapy and use of orthoses, as needed. […] The timeframe of surgical repair is an important factor in recovery. Within 18 months, the muscles that have not already connected to nerves may have weakened to the point where it is no longer possible. […] For avulsion and rupture injuries, there is no potential for full recovery unless surgical repair is done in a timely manner. […] If surgery is needed, microsurgical nerve repair may be undertaken as early as three months post injury. […] Primary nerve repair is typically completed by approximately six months of age following the injury.

• #2 Pediatric Brachial Plexus Care | Children’s Healthcare of Atlanta

  https://www.choa.org/medical-services/orthopedics/hand-and-upper-extremity/brachial-plexus

  Early treatment for a brachial plexus injury often involves physical, occupational or hand therapy at home and in a physical therapy clinic. […] Surgery may be needed if your child has been diagnosed with BPBI or brachial plexus injury, depending on his age, the length of time since the injury, and how well your child can move and function. […] Nerve surgeries are usually only successful when performed within a few months of the injury, which is why early treatment is beneficial. […] Surgery performed soon after a BPBI or brachial plexus injury may include: Nerve repair and grafting. […] This procedure involves the pediatric surgeon connecting part of a nerve with a different purpose to a nerve that is not working in order to restore movement and feeling. […] Surgery for toddlers, school-age children and teens may include: Tendon transfer. […] The pediatric surgeon cuts the bone and moves it to correct or improve the position. […] These surgeries are used to reposition joints to enhance function. They are often used to treat the later effects of nerve injuries.

• #2 Treatment of Brachial Plexus Injuries | BC Children’s Hospital Research Institute

  https://www.bcchr.ca/brachial-plexus/families/treatment

  Botox injections: Botox may be used (mainly for the shoulder) to help with joint motion, re-balance muscles or prevent joint contractures or dislocations. […] Other surgeries: An orthopaedic surgeon may be consulted for additional surgeries or procedures. These may be done earlier in life or on older children who continue to have limitations in the use of their affected arm. […] All treatment suggestions consider your child’s natural developmental progression. We will make suggestions in your treatment program to encourage age-appropriate developmental skills for your child. Visual and tactile stimulation to the affected arm should be continued throughout development; encourage your child in bilateral play activities and use of the affected arm. Children with brachial plexus injuries will learn ways to achieve their arm’s best function.

• #2 Surgical treatment of brachial plexus injuries – UpToDate

  https://www.uptodate.com/contents/surgical-treatment-of-brachial-plexus-injuries

  Surgical treatment of brachial plexus injuries […] Surgical management of brachial plexus injuries requires a multidisciplinary approach including physical medicine and rehabilitation, physical and occupational therapists, neurologists/neurophysiologists, and a reconstructive surgeon with expertise in peripheral nerve surgery. […] The approach to the surgical treatment of brachial plexus injury, including preoperative evaluation, approach to repair, and techniques, is reviewed here. […] Techniques for managing traumatic injuries include nerve decompression, nerve reconstruction, nerve transfers, free functional muscle transfers, tendon transfers, joint fusion, and targeted muscle reinnervation and bionic reconstruction. […] Postoperative care and rehabilitation are essential for achieving functional outcomes.

• #2 Brachial Plexus Injury Treatment – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/services/brachial-plexus-injury/treatment.html

  Nerve recovery can take up to two years, and patients typically return for a follow-up visit approximately every three months for two years after surgery to monitor functional recovery. […] Working with an experienced multidisciplinary team of dedicated specialists who appreciate and employ the full spectrum of possible treatments and can adjust and optimize clinical strategies at each stage grants a huge advantage to patients. […] If surgery is needed, our doctors understand the full array of surgical options and the opportunities for future surgical adjustments as a patient grows older, which allows them to make the best possible decisions at each juncture while taking into account the long-term ramifications for our young patients.

• #2 Brachial plexus condition and treatment – Leeds Teaching Hospitals NHS Trust

  https://www.leedsth.nhs.uk/services/brachial-plexus-injuries/your-condition-and-treatment/

  Passive exercises for the shoulder – only start these exercises when advised to do so by your physiotherapist. You may need assistance from a friend or family member to perform these exercises especially if your whole arm is affected. […] The psychologists in the team are all used to seeing people who have sustained a brachial plexus injury and understand that it takes time to adjust. […] Psychologists can usually help with specific techniques aimed to help with symptoms that you may be experiencing.

• #2 Brachial Plexus Injuries – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/brachial-plexus-injuries/

  A nerve transfer procedure is used when there are no functioning nerve stumps in the neck to which nerve grafts can be connected. […] Patients who delay that first visit to the doctor for more than 12 months after injury tend to have poor outcomes with surgery to reconstruct or repair nerves. These patients are managed better with surgery that focuses on reconstructing the tendon (tendon transfer) or muscle (free-functioning muscle transfer). […] Because nerve regeneration occurs slowly at a rate of approximately 1 mm/day, recovery from a brachial plexus injury takes time, and patients may not experience results for several months. A positive mindset and the support of family, friends, and healthcare professionals are important to recovery and rehabilitation. […] Although brachial plexus injuries can be devastating and difficult to manage, a team approach to treatment has made significant improvements in patient function.

• #2 Traumatic Brachial Plexus Injuries Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1268993-treatment

  Treatment of deafferentation pain begins with conservative measures. A pain management team should be involved early, and admission is often helpful to allow initiation of treatment with a multidisciplinary approach. Antidepressants, anticonvulsants, and narcotics all may have a role, and treatments must be customized to the character of the pain and to the patient. […] Follow-up should be prolonged; neural recovery time is lengthy, with a regeneration rate of 1 mm/day (~1 in./mo). Significant recovery after nerve grafting can take more than 18 months, and maintaining joint mobility, minimizing edema, and treating deafferentation pain during this period can make postoperative care challenging.

• #2 Review of rehabilitation protocols for brachial plexus injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10150106/

  Brachial plexus injury (BPI) is one of the most serious peripheral nerve injuries, resulting in severe and persistent impairments of the upper limb and disability in adults and children alike. […] With the relatively mature early diagnosis and surgical technique of brachial plexus injury, the demand for rehabilitation treatment after brachial plexus injury is gradually increasing. […] Rehabilitation intervention can be beneficial to some extent during all stages of recovery, including the spontaneous recovery period, the postoperative period, and the sequelae period. […] Rehabilitation therapy that has been widely studied focusing on exercise therapy, sensory training, neuroelectromagnetic stimulation, neurotrophic factors, acupuncture and massage therapy, etc., while interventions like hydrotherapy, phototherapy, and neural stem cell therapy are less studied.

• #3 Brachial Plexus – Kids – Mary Free Bed Rehabilitation Hospital

  https://www.maryfreebed.com/conditions/brachial-plexus/

  Our therapists may recommend specialized brachial plexus treatment such as splinting, massage, kinesiotape, pool therapy, threshold electrical stimulation (TES) or neuromuscular electrical stimulation (NMES). […] Your child may be referred for surgical consultation if the injury is more severe and not expected to improve with conservative treatments. […] Physical therapy is typically a key component of rehabilitation after a brachial plexus nerve graft. Your Mary Free Bed therapist will work with you to improve range of motion, strength, and coordination in the affected arm and hand. This may include exercises to stretch and strengthen the muscles, as well as activities to improve fine motor skills, such as gripping and grasping. […] The timing of the start of rehabilitation depends on the type of surgery and your healing process. Typically, it starts a few weeks after the surgery and gradually increases in intensity and duration as your condition improves. Its also important to keep in mind that recovery can take extended periods of time and may require additional medical interventions. Your Mary Free Bed therapist will work with you to set realistic goals and to develop an individualized treatment plan that takes into account your specific needs and abilities.

• #3 Traumatic Brachial Plexus Injuries Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1268993-treatment

  Treatment of deafferentation pain begins with conservative measures. A pain management team should be involved early, and admission is often helpful to allow initiation of treatment with a multidisciplinary approach. Antidepressants, anticonvulsants, and narcotics all may have a role, and treatments must be customized to the character of the pain and to the patient. […] Follow-up should be prolonged; neural recovery time is lengthy, with a regeneration rate of 1 mm/day (~1 in./mo). Significant recovery after nerve grafting can take more than 18 months, and maintaining joint mobility, minimizing edema, and treating deafferentation pain during this period can make postoperative care challenging.

• #3 Brachial Plexus Injuries – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/brachial-plexus-injuries/

  During your discussion with your doctor, it will be important to set realistic goals and expectations for surgical treatment. Nerves heal slowly. The recovery period after surgery is often long and requires a strong commitment to a comprehensive rehabilitation program to restore physical abilities. […] Several surgical techniques are used to treat nerve injury, depending on the type of injury and the length of time that has passed since the injury. […] In most procedures, the surgeon makes an incision near the neck above the collarbone. If the injury extends down the brachial plexus, the surgeon may need to make another incision at the front of the shoulder. […] Nerve repair is typically performed immediately for sharp lacerations to the nerves, such as from a knife wound. […] Nerve grafting is a procedure in which a healthy nerve taken from another part of the body is sewn in between the two ends of a ruptured nerve.

• #3 Brachial Plexus Surgery > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/brachial-plexus-surgery

  An injury to nerves that start in the spinal cord near the neck and run to the arms. […] Treatment includes physical therapy and possibly surgery. […] If a patient does need surgery, it should be scheduled within six months after the injury. […] Severe injuries to the brachial plexus may require surgery, as they wont heal on their own. […] If surgery is required, it should occur within six months of your injury. […] Where the traditional surgery for a brachial plexus involves nerve grafting across the injured segments, Yale Medicine is among the few medical centers offering a new procedure called nerve transfer surgery, which involves more targeted nerve restoration away from the scarred area, and closer to the required muscle function. […] You will need physical therapy after surgery.

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• #3 Traumatic Brachial Plexus Injuries Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1268993-treatment

  Nonoperative treatment of brachial plexus lesions is complex and may best be addressed by an integrated multidisciplinary team that includes a skilled orthotist, occupational therapists, physical therapists, and physicians. Bracing often plays a role in preventing contractures while one is waiting for recovery after surgery or waiting for recovery from neurapraxia. […] There have been reports in the literature assessing cellular therapy as a potential therapeutic modality after traumatic brachial plexus injuries, suggesting augmented clinical benefits with the combination of cellular therapy and rehabilitation. […] Surgical options include nerve (primary) and soft-tissue (secondary) procedures. Primary procedures are reparative in nature; secondary procedures are reconstructive. […] The three crucial factors in restoration of upper-arm function after brachial plexus injury are as follows: patient selection, timing of surgery, prioritization of restoration.

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