The Brachial Plexus Program at The Children’s Hospital of Philadelphia provides comprehensive, coordinated team care for pediatric patients with brachial plexus and peripheral nerve injuries, including birth-related palsies, trauma and peripheral tumors.
Our multidisciplinary program is focused on the evaluation and long-term management of patients from birth through adolescence. We provide a variety of treatment options for patients with brachial plexus and other peripheral nerve disorders, including occupational therapy and surgical interventions.
Team members include clinical experts in pediatric neurology, occupational therapy, neurosurgery, plastic surgery, orthopedic surgery and radiology. Patients treated through the Brachial Plexus Program may also be referred for consultations with other specialists within The Children's Hospital of Philadelphia.
Our program allows for coordinated care in both the outpatient and inpatient setting, depending on the needs of your child. We maintain ongoing, open communication with your child’s primary care physicians and local service providers to ensure coordinated care in the management of your child’s condition.
The brachial plexus is a network of nerves that run from the cervical spinal cord in the neck to the shoulder, arm, and hand. These nerves are responsible for stimulating the muscles of the upper extremity as well as signaling sensation or feeling of the arm. An injury to one or more of these nerves can result in varying degrees of upper extremity weakness or paralysis and numbness.
Types of injury include pulling, stretching, tearing, or compression of the nerve(s). Some nerve injury is temporary, and patients recover most, if not all, function on their own with occupational therapy and time. However, some nerve damage is more severe, and patients with these conditions benefit from surgery and occupational therapy.
Brachial plexus injuries may be related to the birthing process. Older children can also have brachial plexus injuries, which are often related to high impact trauma, such as sports collision or car accident, or a deep cut to the neck area.
Regardless of the type and severity of the injury, it is important for all patients to be evaluated and followed by a medical team that specializes in brachial plexus injuries to monitor their recovery and make recommendations for the best course of treatment. Regular office visits and occupational therapy sessions are important to achieving the best possible outcomes for your child.
Your child’s initial office evaluation is typically done by one of our pediatric specialists and our occupational therapist within the first month after injury. It starts with a medical history, a developmental history, a physical exam and a neurological exam.
When surgery is being considered, your child will be evaluated by our team of surgeons in our multidisciplinary clinic. After a comprehensive examination, we will meet with you to go over the team’s recommendation. Your child’s surgical team meets on a regular basis to discuss treatment plans and progress.
Some children may need additional tests during their care to help the team get a better understanding of their condition and determine best treatment options. An electromyogram (EMG) may be performed by our neurologist to assess muscle contraction. An MRI of the brachial plexus and/or cervical spine, or a CT myelogram may also be ordered through CHOP’s Department of Radiology. In some cases, plain x-rays or ultrasounds may be done to look at the bones or the chest, particularly if there is a history of a fracture or to evaluate the diaphragm for paralysis.
Many patients with birth-related brachial plexus injuries recover enough motion and strength and do not need early nerve reconstruction. For all patients, we encourage regular sessions with occupational therapy, whether it is at The Children’s Hospital of Philadelphia or locally if patients live outside the Philadelphia region.
Your child’s occupational therapist will also teach you exercises that should be performed every day at home with your child to keep the joints supple and encourage appropriate motor development.
Patients are closely followed by our team for signs of functional recovery of the upper extremity. If there are no signs of recovery or not enough muscle recovery, then your child may get additional testing and evaluations to discuss surgical options to improve function.
Early surgical intervention for brachial plexus and other nerve damage is usually decided between three to six months after injury. We carefully follow each patient for signs of recovery and personalize treatment based on the type and degree of injury. Patients may undergo a variety of early surgical treatments, and secondary procedures designed to augment function may be needed as children grow.
For infants born with birth-related brachial plexus injury, please call the Neuromuscular Program in the Division of Neurology at 215-590-1719. Our teams will work together to coordinate care for your child.
For older children with new or past injuries, appointments can be scheduled through the Division of Plastic and Reconstructive Surgery at 215-590-2208, or the Division of Neurosurgery at 215-590-2780.
For directions, maps and parking information, as well as additional details about insurance, referrals, and what you should plan on bringing with you to your appointment, visit our appointments page.
Gregory G. Heuer, MD, PhD
Eric Zager, MD
Robert B. Carrigan, MD
L. Scott Levin, MD
Reviewed by: Ines C. Lin, MD