About the Brachial Plexus Injury Program
The Brachial Plexus Injury Program at Children’s Hospital of Philadelphia (CHOP) provides comprehensive, coordinated team care for pediatric patients with brachial plexus and peripheral nerve injuries, including birth-related palsies, trauma and peripheral tumors.
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 powering the muscles of the upper limb 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.
Regardless of the type and severity of the brachial plexus 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.
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, splinting, and surgical intervention. We carefully follow each patient for signs of recovery and personalize treatment based on the type and degree of injury.
Brachial plexus birth palsy (or neonatal brachial plexus palsy) is an injury to the brachial plexus that occurs during birth, often in infants with high birthweight or following shoulder dystocia (shoulder stuck during delivery). Some of these injuries are referred to as Erb’s palsy.
The cause of brachial plexus birth palsy cannot always be determined. Natural recovery occurs in 60 percent to 90 percent of birth palsies, but 10 percent to 40 percent of infants will have residual muscle weakness.
Occupational therapy and/or physical therapy are important for every infant with brachial plexus birth palsy. Each infant also needs careful evaluation by a multidisciplinary team that can personalize treatment based on the specific injury, including BOTOX® injection, splinting and casting, and surgery.
Traumatic injuries to the brachial plexus can occur during sports or from a motor vehicle collision. Initial evaluation of these injuries often requires magnetic resonance imaging (MRI) or electromyography (EMG) and nerve conduction studies (NCS). Each child needs an evaluation by a multidisciplinary team that can individualize treatment based on the specific injury pattern.
Our Brachial Plexus Injury Program team includes clinical experts in pediatric neurology, occupational therapy, orthopaedic surgery, neurosurgery, plastic surgery and radiology. 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.
For infants, children and adolescents with brachial plexus injuries, please call the multidisciplinary Brachial Plexus Program at 215-590-1527 to begin the scheduling process. The lead occupational therapists for the Brachial Plexus Injury Program (Sandy Schmieg or Meagan Pehnke) will reach out to you to find out more about your child and help plan your first visit with the Brachial Plexus Injury Program team.