Treatment of Brachial Plexus Injuries

Physiotherapy

Physiotherapy should begin early in the infant who has a brachial plexus injury. Therapy cannot heal the nerves faster but will help prevent further problems like development delay and joint stiffness and help strengthen the recovering muscles. Your child's physiotherapist will design a treatment plan that is specific for your child. 

Range of Motion Exercises

These exercises are movements done with your child’s arm to ensure that the joints maintain full movement. Movements should be performed slowly and held at the end point. Range of Motion exercises should be done at least twice daily.

Range of Motion Exercises for Infants (102KB PDF)

Tactile and Visual Stimulation

It is important to provide stimulation to the affected arm to match the stimulation received by the unaffected arm. You can do this by rubbing different textures over it and by taking the palm of the affected hand to the face and mouth. It is also important to bring the affected hand into the child’s line of vision.

Positioning

The child’s affected arm should be positioned to copy the unaffected arm. Laying on the affected arm is not a concern. Tummy time is recommended as well. When dressing, it is best to remove clothing from the affected arm last and to dress the affected arm first. 

Strengthening

It is important to encourage active use of the child’s affected arm and hand.  

Splinting

If your child has tight joints that may be difficult to help stretch, a splint (positioning support) may be recommended. These splints are usually custom made, specifically for your child and their needs by an occupational therapist. Read more ...

Additional treatments

  • Nerve surgery: In some cases, surgical exploration of the nerves is required to improve the function of the arm. This is usually done in the first year of life.
  • Botox injections: Botox may be used (mainly for the shoulder) to help with joint motion, re-balance muscles or prevent joint contractures or dislocations. Read more ...
  • Other surgeries: An orthopaedic surgeon may be consulted for additional surgeries or procedures. These may be done earlier in life or on older children who continue to have limitations in the use of their affected arm. 

Development

All treatment suggestions consider your child’s natural developmental progression. We will make suggestions in your treatment program to encourage age-appropriate developmental skills for your child. Visual and tactile stimulation to the affected arm should be continued throughout development; encourage your child in bilateral play activities and use of the affected arm. Children with brachial plexus injuries will learn ways to achieve their arm's best function.  

Tummy time is essential for development and strengthening of children with brachial plexus injuries and can be introduced as early as you like. Encourage crawling when the child is developmentally ready.

Pathways.org Essential Tummy Time Moves (854KB PDF)