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Brachial Plexus Program

CHOC offers the only pediatric Brachial Plexus Program in Orange County, providing a team approach to treatment for babies and children who have damage to the brachial plexus and peripheral nerves.

Our multidisciplinary program offers families:

A comprehensive evaluation to determine the extent of nerve damage and how it affects your child’s shoulder, arm, elbow, wrist and hand
An individualized physical and occupational therapy program to help your child improve function of their upper extremity
The latest techniques in surgery and microsurgery by board-certified plastic surgeons, neurosurgeons and orthopaedic surgeons who work as a team in the OR depending on your child’s needs
Coordinated follow-up visits to monitor your child’s recovery and ensure they are meeting functional milestones as they grow.

Frequently Asked Questions About Brachial Plexus

What is the brachial plexus?

The brachial plexus is a group of nerves on each side of the neck that branches down into the chest, shoulders, arms and hands. These nerves control the motions and feeling of the wrists, hands and arms.

What happens when the brachial plexus is damaged?

The brachial plexus can be damaged in many ways-—from pressure, stress or being stretched too far. Damage to the nerves cuts off communication between the spinal cord and the arm, wrist and hand. This may mean that a child can’t use their arm or hand. Damage to the brachial plexus can also cause loss of sensation in these areas.

The severity of a damaged brachial plexus varies. In some people, function and feeling returns to normal. Others may have lifelong issues because they can’t use or feel a part of the arm.

What causes damage to the brachial plexus?

The most common type of damage happens when the neck is tilted while traction happens on the other side of the neck. However, injuries are varied, and can happen from motor vehicle accidents, falls, athletic injuries (especially contact sports), and childbirth.

What are the symptoms of brachial plexus nerve damage?

Symptoms depend on where along the length of the brachial plexus the damage happens and how severe it is. The most common symptoms are inability to move or control the arm, wrist or hand; an arm that hangs limply; and no feeling in the hand or arm.

How is brachial plexus nerve damage diagnosed?

At your child’s first appointment with the Brachial Plexus Program, a pediatric plastic surgeon and an occupational therapist will provide a comprehensive examination of your child’s hand and arm function and sensation, to help diagnose brachial plexus nerve damage. The team will discuss a treatment plan with your family, provide a home program to facilitate recovery and refer to therapy services, which are a critical part recovery.

Other diagnostic tests that may be used include:

MRI scan
CT scan
Tests to determine nerve function and electrical activity, including a nerve conduction study and electromyogram
X-ray of the neck and shoulder area

How is brachial plexus nerve damage treated?

Physical and occupational therapy can help restore functional movement and flexibility in your child’s arms and hands. Approximately 10 percent of children with brachial plexus nerve damage also require surgery to repair the damage. Following treatment, your child will have regular checkups to monitor their recovery and ensure they are meeting functional milestones. Learn more about rehabilitation and surgical treatments for the brachial plexus.

When a Baby Has Brachial Plexus Birth Palsy

Baby girl standing with parents During childbirth, a baby’s brachial plexus may get stretched, resulting in brachial plexus birth palsy (sometimes called Erb’s palsy). This affects between 1 and 2 babies in every 1,000 births. Large babies may be at an increased risk for brachial plexus damage. Babies in breech position (bottom end comes out first) and those whose labor lasts an unusually long time may also have brachial plexus damage.

Babies with birth palsy may not be able to flex and rotate the arm. If the damage is limited to bruising and swelling around the nerves, a child should be able to use their arm normally within a few months with the help of physical therapy. If the nerve was torn, or if movement does not return after a few months, additional treatment such as surgery may be needed.

Babies born with birth palsy should receive treatment as early possible to have the most ideal recovery and benefit from the most minimally invasive treatments.

Brachial Plexus Recovery: The Very Latest Methods of Rehabilitation and Surgery

young brachial plexus patient smiling in hospital

Surgery

About 10 percent of children with brachial plexus nerve damage will need surgery to help them recover. Surgical procedures such as nerve grafts and transfers can restore function and sensation and help the child regain their quality of life. Some children may need a series of procedures. As children grow, they may need tendon transfers, osteotomies and free-functioning muscle transfers to restore function.

After surgery, a child will wear a custom splint to protect the nerves while they heal, and will work closely with our occupational and physical therapists during recovery.

CHOC surgeons are trained to use the latest surgical methods, and are committed to evidence-based procedures to provide the best outcomes for your child. They will follow your child as they grow to ensure that they are receiving the best treatment available.

Watch a CHOC physical therapist demonstrate how aquatic therapy helps a baby regain movement and function after damage to the brachial plexus.

Occupational Therapy and Physical Therapy

Most children will recover with minimal long-term effects after undergoing occupational and physical therapy. CHOC offers the latest, research-based therapy in one of the most comprehensive rehabilitation centers in the area. In addition to traditional therapy, some brachial plexus patients may benefit from aquatic therapy, which is offered on-site in a therapeutic pool, as well as electrical stimulation and/or kinesiotape.

Therapists will focus not only on the involved body part, but also the whole body, assessing symmetry, posture and quality of movement, with overall functional mobility. CHOC therapists will also create an individualized home program based on a child’s needs, and provide regular family education at each treatment session.

High Level of Care for Brachial Plexus Surgery

CHOC’s experienced multidisciplinary team is fully equipped to handle all aspects of a child’s brachial plexus repair. “We like to evaluate patients as early as possible,” says Dr. Amber Leis, CHOC plastic surgeon and certified hand specialist. “We want to be part of the child’s journey and provide long-term care to ensure the best possible outcome.”

Dr. Amber Leis