Brachial Plexus Injuries Health Article

Recovery and rehabilitation

Rehabilitation for BPI primarily entails physical therapy (PT) during the entire treatment course (acute, recovery, and maintenance treatment phases). The focus of PT during the acute phases primarily involves early mobilization and icing. Patients attempt to improve cervical range of motion to strengthen cervical muscles. During the recovery phases, special PT programs attempt to strengthen cervical muscles to a level of performance prior to injury. Special focus on muscles supporting the injured brachial plexus nerve (i.e., cervical and shoulder regions) is emphasized. Treatment for the maintenance phases primarily focuses on continuation of cervical muscle strength and conditioning. Clinical findings during examination and testing are key factors for determining return to play and recovery. A full recovery of affected muscle is necessary to prevent recurrence of burner syndrome and further injury. An athlete in a contact sport, who has fully recovered, is capable of supporting his or her weight at the neck leaning at a 45 degree angle. Some athletes may have some asymmetry of affected muscles that persists, and care should be taken as the athlete returns to contact sport participation.

Most infants with OBPI spontaneously recover (92-95% of reported cases) because the nerve injury is usually minor. Initial rehabilitation can include physical therapy to maintain passive range of movement. Surgery may be necessary for severe cases that require special postoperative care, monitoring, and physical therapy. Recovery for children with OBPP depends on the severity of nerve injury. Recovery after surgery is variable given that results depend on extent of damage to nerves and successful repair if surgery is indicated.

Prognosis

Prognosis for sports-related BPI is generally good. Some athletes develop a chronic complicated condition with symptoms called chronic burner syndrome. Most cases of nerve injury in infants are self-limiting and spontaneously resolve. Severe cases may require surgery. Surgical candidates typically have severe nerve injury and must undergo microsurgery to repair nerve damage.

Special concerns

In sports-related injury medical/legal problems can exist because cervical spine injury is sometimes not considered the cause of symptoms. Overlooking BPI can result in further damage to peripheral nerves.

PERIODICALS

Clancy, W. G. "Upper Trunk brachial plexus injuries in contact sports." American Journal of Sport Medicine 5, no. 5 (1977).

WEBSITES

Brachial plexus injury. <http://www.mayoclinic.org>.

Brachial plexus injury. <http://www.cincinnatichildrens.org>.

Laith Farid Gulli, M.D.

Robert Ramirez, D.O.