I am Dr. Adhishwar Sharma, Cosmetic/Plastic Surgeon. I have a special interest in brachial plexus injury both adult and pediatrics. In children, it is known as obstetric brachial plexus injury (OBPI). Mainly it occurs in overweight babies, pre-diabetic mothers or diabetic mothers. Birth canal obstruction is the major cause of these injuries. Now, these injuries have various types. There can be small traction or complete palsy. The amount of injury to children is less and growth potential is great. And with proper surgery, physiotherapy and management limb can be restored. Coming to the types of injury, it could be minor little bit tractions in injuries which recovers within 3 months and it could be a serious injury which shows no signs of recovery.
Treatment of each patient is individualized. The basic outline of the management, in 1st and 2nd month we do physiotherapy in order to keep joint soft and supple. In 3-6 months if there is no development of bicep or not showing any sign of recovery than a child needs surgery on an urgent basis. We usually prefer to do nerve surgery till 3-9 months. A surgeon can decide to operate the children and to move the neurolysis and nerve transfers. Once the recovery comes, the muscles which are more powerful and recover early or if they do not recover fast they may develop contractures.
For which botox is required along with physiotherapy. Once the child reaches 2-5 years of age if the surgery is going at the expected stage. If the child has not undergone nerve surgery or botox also, they start developing shoulder deformity for which they need muscle and tendon transfer in order to achieve good shoulder function. The patient often develops deformities of elbow, wrist, fingers, and thumb. This needs straightening of all these deformities. All these are conducted by physiotherapy and results especially in children are great. With these, a child could get a good life.