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In the next of our series of blogs raising awareness of Erb’s Palsy we look at the different therapies and surgical options that can be considered.
Injuries to the brachial plexus nerves, which are responsible for Erb’s Palsy, can be treated in different ways depending on the nature and severity of the injury, which was considered in more detail in Hannah’s previous blog. The clinician overseeing treatment of the injury will recommend which type of treatment is most appropriate.
If physiotherapy is deemed the most appropriate type of treatment, once referral to a physiotherapist has taken place, the therapist will first assess the nature and extent of the impairment caused by the injury before setting out the aims and methods of treatment and making recommendations designed to accomplish those aims.
The goals of the physiotherapy treatment will very much depend upon the context of the referral. For example, in the case of a less severe injury physiotherapy may be the main form of treatment with the aim of ensuring full recovery of the affected arm. Where there is a more severe injury physiotherapy may take place in the context of surgery. In this scenario physiotherapy will constitute part of the recovery plan, aimed at ensuring the muscles of the impaired arm are used and strengthened in a guided and measured way, to ensure maximum rehabilitation after surgery. Physiotherapy may initially take place in the presence of the physiotherapist, but will usually always also involve exercises and stretches to be performed at home.
Sometimes surgical intervention is considered the best way to achieve maximum recovery and different procedures will be offered, depending on the type and extent of the injury.
The types of surgery which may be offered include:
Nerve Grafts: This procedure may be offered where nerves have been ruptured. Part of the damaged nerve is removed and a section of healthy nerve is inserted in its place. The healthy nerve is used to bridge the gap caused by the damaged nerve and aims to ensure nerve messages are properly communicated where they would otherwise be disrupted. The aim of this surgery is to help restore some of the movement and function which has been lost in the affected arm.
Shoulder Release: This procedure may be offered where external rotation of the shoulder has been reduced. This often manifests as internal rotation of the shoulder and means that it is very difficult to turn the arm outwards (for example, when putting on a coat). Loss of this movement may be a symptom of an internal rotation contracture.
This operation is aimed at enhancing shoulder rotation by releasing the muscle and hence allowing the shoulder to return to a more natural position. A plaster cast must be worn following this surgery to hold the shoulder in the correct position and to allow for the proper healing of the released muscle.
Tendon Transfer: This procedure is generally performed prior to 7 years of age and may be offered where active external rotation of the arm has been lost. This often happens with Erb’s Palsy injuries because the muscles in the rotator cuff, which usually perform the function of turning the arm outwards, are damaged.
This procedure involves the transfer of a tendon known as the Latissimus Dorsi from it usual position, slightly to the back of the ribcage (where it turns the arm inwards) to the rotator cuff, where it can then be used to turn the arm outwards. As with shoulder release surgery, a plaster cast will need to be worn following this procedure.
The treatment of each type of injury will be different and may involve one, or a combination, of the above methods. This is only an overview and further detail of treatment options should only be sought from suitably qualified surgeons and therapists.
In our previous blog we considered the different degrees of peripheral nerve injury that can be suffered. In our next blog we will look at circumstances when brachial plexus injuries can be suffered as a result of negligence during the birth of a baby.