Postnatal paresis of the brachial plexus

Brachial plexus is a bundle of nerves led from the spinal cord from the 5th cervical and 1st thoracic vertebrae. With its nerve fibres it spreads to the arms > they secure movement and also sensitivity of the upper extremities.

Paresis (polio) of the brachial plexus is the most frequent damage of the peripheral nerves in a newborn babies. It can occur by a traumatic childbearing when the child is being pulled too hard out by the head, as well as by shoulder dystocia (the baby is “jammed” by the pubis bone of the mother) and by macrosomic (large) baby. Prevention is consisted of prenatal diagnosis. The size of the baby should be determined, as well as size of the pelvis, and presence of any abnormalities in the pelvic area of the mother. This occurs in 1 - 2 from 1000 born children.

First examination of the newborn child with polio of the upper extremities performed by neonatologist must always exclude fracture of the collarbone or arm bone, ribs and luxation of the shoulder joint. Treatment is multidisciplinar (child neurologist, physiotherapist, pediatrician, plastic surgeon, neurosurgeon and child psychologist) it can also include rehabilitation, electrostimulation, therapy of the fracture and subluxation, applying botulotoxin, neurolysis, neuroma removal, relief of the muscle contractures and transplantation of the muscle tendons.

The most common type is paresis caused by depression, inner rotation and adduction of the shoulder, extension of the elbow, pronation of the forearm and flexion of the had. With this type of polio is affected mainly shoulder joint and wrist, fingers are usually functioning. In the past was this problem usually treated surgically. However due to high mortality rate after surgical treatment in newborn babies, are doctors more and more choosing conservative approaches. If the condition of the child in the first 4 and half months is not leading to partial recovery of the function of the thigh and deltoid muscle (m. biceps femoris and deltoid muscle), surgical treatment is indicated - reconstruction of the nerves. During avulsion (forcible detachment) is surgery performed right after the child is born.

If the condition of the child is adjusted, it is complete and within first few months of the child’s life. Persisting polio is a serious handicap, which restricts functions of the arm and hand. Lifelong rehabilitation care will be necessary to restrict muscle contractures and atrophies.

REHABILITATION:

Positioning the restricted extremities

• Position on stomach with the affected extremity in slight bend in the elbow joint, keeping it closer to the body

Massage

• Light friction for easier outflow of the venous blood

Warming up

• Supported perfusion of the extremity, myorelaxant and analgesic effect

Physiotherapy

• Static stretching
• Mobilization of the soft tissues and joints
• Vojta principle of the reflexive locomotion
• Bobath concept
• Postural program - J. Čápová
• Sensomotoric stimulation
• Proprioceptive neuromuscular facilitation

Physical therapy in later age

• Electrostimulation

Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic