Dr. Pamela B. Salazar, M.D.

Brachial plexus injuries occur in approximately 4 per 1000 births. Signs of trauma to the Brachial Plexus at birth include a limp, motionless arm that is abnormally postured. Causes of BCP stretching or tearing the nerves in the neck are due to difficult labor, large birthweight and breech birth. The clinical signs of BCP relate to the site of nerve injury. Feeling and temperature regulation as well as movement of the affected arm may be impaired. The degree of nerve injury will impact the natural recovery of the movement and feeling of the arm. If the nerve is severely stretched but not completely torn, a full recovery of the arm may take 12 to 14 months. If the nerve is torn, surgical intervention will be needed to facilitate nerve recovery. Recovery is also affected by the timing of medical and rehabilitative intervention. Infants who receive early evaluation and treatment stand a better chance of recovering functional use of the arm. Without early intervention, the infant may develop contractures and deformities that will interfere with the functional use of the extremity.

Intervention in the first weeks of life focuses on proper positioning of the arm to prevent further damage and to increase the infants' awareness of the arm. Occupational therapists can train the parents to provide the limp arm with passive movements to maintain flexibility. Splinting may be necessary to control movement across the elbow or wrist joint if stronger muscles are pulling against the weakened muscles. Play therapy approaches are incorporated into the pediatric therapists approach to make the treatment as engaging and pain-free as possible. Electrical stimulation to the weak muscles can be used to promote tone and strength in the muscle while it awaits the recovery of nerve function.

Augusta is fortunate to have a multi-disciplinary clinic designed to meet the needs of infants and children with BCP. The clinic is held at the Medical College of Georgia and is attended by a pediatric physiatrist, pediatric neurologist, pediatric neurosurgeon and a hand surgery specialist. Dr. Salazar, Medical Director at Walton Rehabilitation Hospital, is a collaborative physician at the MCG clinic in rehab medicine. Patients needing therapy for functional deficits are referred to Walton, MCG and Hitchcock for rehabilitation.

The clinic is open to any patient who has suffered a brachial plexus lesion. Surgical and non-surgical treatment options will be explained along with access to pediatric occupational therapy. To call for an appointment call Kim in the Department of Pediatric Neurosurgery at 706-721-3071.