Unnerving movements

Brachial plexus injuries, usually seen at birth, can either be temporary or chronic in nature

BENGALURU: Is my baby moving fine? This is a question every caregivers ask about their baby’s movements. Since the initial few days are important for the baby’s growth and movements, caregivers should monitor the hand and leg functions closely. In some cases, it is noticed that the baby is unable to move one side of the arm, wrist and fingers. This condition is commonly known as Brachial Plexus Injury. This injury is usually seen at birth, occurring in about 1 to 3 births out of 1,000.

Brachial plexus is a group of nerves derived from the nervous roots in the cervical and the upper trunk, which are sections of the spinal cord. They stretch through the shoulders and down the arms of the nerves rooted in the neck. These nerves control the movements of your wrist, hands and arms. Babies are generally vulnerable to the brachial plexus nerves on their shoulder at birth.

Predominant causes 

•  Large gestational size
•  Breech birth
• Prolonged or difficult labour
•  Vacuum- or forceps-assisted delivery
•  Twin or multiple pregnancy
•  Maternal diabetes
•  History of a prior delivery resulting in brachial plexus birth injury

Symptoms 
1 Severe pain in shoulders or arms
2Arm may appear to be limp or paralysed
3Decreased movement or sensation in the upper extremity
Babies are rarely in pain, owing to the fact that their nerves operate differently from adults. Only about 4% of babies appear to be in acute discomfort. 
Incontrast, an adult may sustain a traumatic brachial plexus damage as a result of an accident or sports collision.

Treatment
Brachial plexus injuries do not usually necessitate treatment. Some people, particularly babies born with a brachial plexus birth damage or adults with neuropraxia, recover without therapy. However, in other cases, the injury can take weeks or months to heal.

When to undergo surgery
If your kid’s health has not improved after three months of occupational therapy, it is imperative to contact a paediatric neurologist at first. In cases where extra procedures or surgery may be necessary, a hand surgeon trained by in brachial plexus surgery is to be contacted to assess the situation. If the injury has occurred during birth, the best time for surgery is when the child is between 4 to 9 months.

(The writer is consultant - hand, wrist and microvascular surgery, orthopaedics, Manipal Hospitals, Malleswaram)