Brachial Plexus Injuries in Children

About Brachial Plexus Injuries in Children at Kayakriti

Most paediatric brachial plexus injuries occur during difficult deliveries, particularly with shoulder dystocia, large babies or instrumented birth. The result is a flaccid or weak arm, often with a typical posture of internal rotation and inability to lift the shoulder. While many infants recover spontaneously, those with persistent deficits at three to six months need specialist review to plan timely intervention.

Initial evaluation is gentle and child-friendly. We document movement at the shoulder, elbow, wrist and hand, look for Horner's sign and check sensation indirectly through reactions. Serial examinations every few weeks are essential because clear improvement in elbow flexion by three to six months is a strong positive sign. Early imaging is reserved for select cases where avulsion is suspected.

Children who do not regain antigravity elbow flexion by three to six months are candidates for nerve reconstruction. Surgery may include neurolysis, sural nerve grafting across ruptures and selective nerve transfers to restore shoulder and elbow function. Procedures are tailored to the injury pattern (Erb's, extended Erb's or total) and the child's age, weight and overall health.

Beyond nerve reconstruction, children frequently develop secondary issues such as shoulder internal rotation contracture and posterior subluxation. Botox injections, soft-tissue releases, tendon transfers and humeral derotation osteotomy may be added later to maintain a balanced shoulder. Dental, orthopaedic and rehabilitation specialists work together with our plastic surgical team to support overall growth.

Postoperative care is gentle and family-centred. Splints are kept light and comfortable, and parents are taught safe handling, basic exercises and signs to watch. Children are reviewed every two to three months to track motor recovery, joint development and contracture. Nerves regrow over many months, so early signs of return often appear at six to twelve months after surgery.

Long-term follow-up continues into school age and beyond. We monitor shoulder shape, elbow function and hand strength as the child grows, and plan secondary procedures only when they will improve daily life. Our team supports parents with clear communication, written care plans and structured reviews so that surgery, physiotherapy and growth fit together coherently throughout childhood.