Brachial Plexopathy
The Duke Pediatric Brachial Plexopathy Clinic was established to offer multidisciplinary care for children with obstetric brachial plexopathy (OBP) who are not recovering function spontaneously. One of our goals is to determine as early as possible which children are not likely to recover adequate function on their own and whether or not surgery is a good option for them. This requires a coordinated approach involving multiple medical specialties, including pediatric neurology, neurosurgery, orthopedics and occupational therapy.
What is the brachial plexus?
The brachial plexus is formed by a complex network of nerves that leaves the spinal cord in the neck and provides nerve signals to each arm. When these nerves are injured, the result is variable degrees of weakness in the shoulder, arm or hand on the affected side. There are often problems with sensation (feeling pain or temperature) on the affected side as well.
What causes brachial plexus injuries?
There are many causes of brachial plexus injury (“brachial plexopathy”), including trauma, infection, and cancer. In newborn babies, the most common cause of brachial plexopathy is stretching of the plexus during a difficult delivery. Often, the shoulder on the affected side “gets stuck” during delivery, particularly when the baby is large. This is called “shoulder dystocia.” However, in up to 50% of cases, there is no history of shoulder dystocia. Brachial plexopathy in a newborn is often referred to as “obstetric brachial plexopathy” (OBP). Unfortunately, OBP is a relatively common occurrence (roughly 1 per 1000 live births). This number has not changed significantly over the past 30 years even though the cesarean section rate has increased from 5% to 20% over the same time period. The right side is more frequently affected than the left. This likely reflects the fact that babies are bigger at birth today than they were several decades ago. Fortunately, the vast majority of children with OBP make successful recoveries. Full, spontaneous recovery occurs in about 7 out of 10 of children. In the remaining 30%, the children are left with variable degrees of weakness.
Treatments
Treatment options depend on the type and severity of the injury. Mild injuries may heal themselves. More serious injuries will require surgery to repair injured nerves.
There are several therapies available that are used in attempt to improve outcome in OBP. Most physicians recommend starting regular physical or occupational therapy as soon as possible in an effort to keep the joints mobile. The therapists work with parents to teach various stretching exercises and devices such as a wrist splint may be prescribed. Depending on the severity of the injury, recovery may be slow, typically taking months, not weeks. If the nerves were simply stretched, the prognosis for recovery is quite good.
If a child is not demonstrating adequate recovery of function, the doctor might order tests to help determine how severe the injury actually is. Magnetic Resonance Imaging (MRI) provides a powerful picture of the spinal cord and nerves of the brachial plexus. It may show evidence that one or more nerves were torn (“avulsed”) from the spinal cord. This is important to know as a torn nerve will not recover on its own and will likely require surgical intervention. Similarly, a test called “electromyography” (EMG) might be done to help the doctor determine whether or not surgery is necessary. As the child grows, the orthopedic surgeon may recommend surgery on bone, joint or muscle to improve function.
Research. There are many unanswered questions regarding OBP, and our clinic also serves a research purpose. We would like to not only answer which children might benefit from surgery, but how soon should surgery be done? What type of surgery is most effective and carries the least risk? What are the most reliable tools available to help the doctor accurately counsel parents regarding prognosis? Are there effective non-surgical therapies beyond traditional physical or occupational therapy? By following enough children over a long enough period of time we will, hopefully, be able to begin to answer some of these questions more accurately.
Physicians and Staff
Physicians
| Name | Areas of Special Interest |
|---|---|
| Gerald A. Grant, MD | Pediatric neurosurgery, pediatric brain tumors, pediatric epilepsy, Chiari malformations, pediatric spinal disorders, minimally invasive endoscopic surgery |
| Fraser J. Leversedge, MD | Hand, upper-extremity, and microvascular surgery; clinical conditions affecting the upper- extremity distal to the shoulder, including trauma, arthritis, nerve/tendon repair and reconstruction; pediatric/congenital disorders, sports injuries, and post-traumatic reconstruction |
| Jeffrey R. Marcus, MD | Cosmetic and reconstructive procedures involving the face including rhinoplasty (cosmetic and functional), cleft lip and palate repair, surgery to treat facial paralysis, craniosynostosis, and other craniofacial conditions |
| Edward C. Smith, MD | General child neurology with special interest in neuromuscular disorders |
Occupational Therapists and Staff
| Name | Role |
|---|---|
| Lilie Bonzani |
Occupational Therapist |
| Rebecca Rogliatti |
Occupational Therapist |
| Kimberly Bradsher |
Administrative Assistant |
Clinic Hours and Location
3000 Erwin Road
Durham, NC 27705
Tel: 919-664-6669
Hours: Third and fourth Wednesday of each month, 8:30am - 12:00noon
Appointments and Contact Information
The Duke Brachial Plexopathy Clinic is dedicated to providing comprehensive medical and surgical care to infants and children with brachial plexus injuries. Patients will receive diagnostic evaluations, routine follow-up assessments and coordinated, multidisciplinary care.
- For appointments, please call Kimberly Bradsher at 919-668-4000.
- For physicians requesting consultations or making referrals, please call the divisional office at 919-668-0477 or the Duke Consultation and Referral Center at 800-MED-DUKE (800-633-3853).
Duke Resources
Web Sites
- Duke Children's Neurology Services
- Pediatric Division of Neurology
(Duke School of Medicine)
