Because severe injuries require early intervention, it’s important for infants to undergo specialized testing to determine the precise location and level of injury to each nerve within the brachial plexus. Testing normally takes place within a month after the injury. Electromyogram (EMG), magnetic resonance imaging (MRI), X-rays, and ultrasound may all be used to determine the exact sites and severity of the damage.
Those injuries where the nerves are only stretched, not torn, are generally temporary. Additionally, not all of the nerves may be injured, resulting in injury to only a part of the arm with as many as two-thirds of brachial plexus injuries fully healed on their own within a few months. Most children benefit from some form of physical therapy which can maximize motor function and promote increased signals to the brain. Parents can take an active role to maximize recovery by learning to perform daily range-of-motion exercises with their baby as early as one month after birth.
More severe injuries, where some nerves are partially or fully torn, require early intervention with occupational therapy and surgery. Nerve injuries are difficult to treat because completely severed nerves cannot regenerate on their own. Stretched and strained nerves may heal, but they may also be covered in scar tissue, causing pressure on the affected nerve. Early nerve repair surgery, as early as three to six months, may be necessary because muscles that have not been linked to nerves within 18 months of the injury may be too weak to repair. Completely severed nerves, particularly those close to the spinal cord, may be permanently damaged and may only partially recover. However, nerve grafts and nerve transfer from less used muscles have been able to restore some function.
For severe injuries, secondary surgical interventions may also be needed to allow children to grow properly and increase the function of muscles and bones. These surgeries include muscle and tendon transfers, repositioning of bones, and joint fusion. Frequent occupational therapy is also prescribed to promote nerve recovery, prevent muscle rigidity, and maintain range of motion. The therapist may also split the joint, perform compression and weight-bearing exercises, or advise aquatic therapy.
Children’s recovery should be closely followed and frequently re-evaluated in order to determine if additional treatments are needed.