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Brachial Plexus and Peripheral Nerve Clinic

If Your Child Needs Surgery

Many children with brachial plexus and peripheral nerve injuries will regain function and feeling in their arms and hands over time with physical and occupational therapy. For others, the right course of treatment is surgery.

To determine whether surgery will help, your child’s neurosurgeon may order magnetic resonance imaging (MRI) and nerve testing – using an electromyogram and nerve conduction studies to measure the electrical activity in the muscles and nerves.

If the injuries to your child’s nerves are severe, particularly if there are nerve tears or ruptures, your doctor may recommend a surgical procedure.

What Surgical Options Are Available?

Common surgical treatments for brachial plexus injuries include:

  • Neurolysis/neuroplasty – Surgeon removes scar tissue from around the injured nerves because scar tissue may be compressing the nerves; goal is to relieve pain and disability.
  • Nerve graft – A healthy nerve is taken from another part of the body and sewn between two ends of a ruptured nerve; may use artificial or cadaver nerve tubes; the nerve graft acts as a bridge between severed nerve ends; goal is to create paths for new nerve connections.
  • Nerve transfers – Functional nerves are transferred to non-functional nerves; goal is to regain function by providing a signal to a paralyzed muscle.
  • Tendon releases and/or tendon transfers – The tendon of a functioning muscle is sewn into a nonfunctioning muscle tendon to restore a specific motion or motor function; used to improve function when nerve surgeries do not work.
  • Muscle transfers – When disability persists into early childhood, muscle transfers are a microsurgical reconstructive option that involves moving a muscle from another part of the body, typically the leg, to restore motion in the arm.
  • Joint and/or limb reconstructions – Bone and joint surgeries can help reposition the arm and hand into a more functional or stable position to optimize the motion available to a child.

When Should My Child Have Surgery to Repair the Nerves?

Your child’s neurosurgeon will determine the best time for your child to have surgery. Often, surgery takes place between three and six months after the injury, allowing time for the shoulder, arm or hand to regain as much movement and strength as possible on its own.

Also, the nerves will react to surgery best during this timeframe and have a higher chance of reaching the muscles they are supposed to reach for nerve reconnection.

If surgery is delayed too long, your child may be at risk for:

  • Insufficient nerve recovery, where the arm may become “stuck” in a position that doesn’t allow child to perform normal tasks and activities of everyday living and play
  • Incomplete growth of the arm
  • Differences in function and capability of the arms
  • Chronic pain

After Your Child’s Surgery

  • Your child may need to wear an arm sling or a cast, allowing the arm, nerves, muscles and tendons to heal properly.
  • Your child’s surgeon will instruct you on how and when you should move your child’s arm.
  • You and your child will have follow-up visits with the surgeon to assess how your child is healing.
  • Your surgeon will recommend occupational or physical therapy after your child has healed sufficiently. Therapy is essential to maintain range of motion, monitor scarring and help your child regain the ability to use the arm to perform tasks.
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