Mason's Journey in the Land of Brachial Plexus Part 2

Brachial Plexus Blog Part II

What is a Brachial Plexus birth injury?

As I mentioned before one to three out of every 1,000 births are Brachial Plexus injuries. The Brachial Plexus is actually a complex set of nerves located between the neck and shoulders. These are the same nerves that control muscle function within the upper extremities: shoulder, arms, and hands. So the brain can send signals to the nerves but the nerves are unable to send those signals to the arm, shoulder or hands.
 

This injury is usually caused during a difficult delivery. The injury is caused by stress to the child’s neck, and shoulder area as they pass through the birth canal.
 

There are various levels of injury. Sometimes the nerves are just bruised, stretched or could be severed. Usually when the nerves are just stretched children can show improvement or fully recover within 3 months. Other injuries may be more severe and will take longer to show improvement.

How severe is Mason’s injury?

Mason was able to move his right hand from birth, he always had a firm grip, however he couldn’t bend his arm on his own and his arm was turned out.

After 3 months of weekly physical therapy Mason was showing improvement but couldn’t bend his arm against gravity. Each month we would visit with Dr. Abzug, a Pediatric orthopedic specialist at the University of MD to see how his arm was progressing.
 

My husband and I were hopeful that he would improve even after we passed the 3 month benchmark. Although he wasn’t fully recovered he was making great strides with therapy. In order to avoid a tendon transfer surgery at 6 months Mason had to bend his arm against gravity.

Imagine our surprise during Mason’s 4 month appointment with Dr. Abzug when he bent his right arm against gravity! My husband and I were elated, no surgery at 6 months. However, we were still not out of the woods yet. Mason made progress but he still needed better range of motion.

What’s Next?

Mason has steadily improved but elbow flexion is still a challenge. Basically if you bend his right arm at 90 degrees, keeping the elbow tucked close to the body and attempt to stretch it away from the body it does not have the same range of motion as the left arm.
 

We sought additional assistance from the Brachial Plexus center at Kennedy Kreiger (John’s Hopkins).  He had aggressive Occupational Therapy (OT) twice a week in addition to Physical Therapy (PT) once a week.  Mason did show improvement but the elbow flexion was still an issue. In addition, the therapists felt that we should get an MRI to check the shoulder joint.

 

At 7 months we had an MRI to check Mason’s shoulder. The results showed this slow progression was due to the fact that his shoulder joint is not properly aligned within the socket. Dr. Abzug laid out our choices, we could do three things:

• Nothing
• Botox injections: This would relax the muscles that keep Mason’s arm turned inward. Then he would wear a cast for 3 weeks to stabilize the shoulder and keep stretch his arm outward in the proper position.  Followed by aggressive OT.
•  Wait until he’s closer to a year and have a surgical procedure where he would have to wear a cast for longer than 3 weeks.

Decisions, Decisions

Of course my husband and I want our son to have the best quality of life so doing nothing was not an option. At the time Mason was too young for surgery, so we elected the non-evasive procedure, botoxing. Mason is scheduled to have his procedure done in late May and we are hoping that with the aggressive OT he will continue to improve.

Righty

“Righty” is the nickname we have given to his right arm. Looking at Mason at 9 months you can barely tell that he has an issue. He can pick up things with his right arm: reach, he can even push up on it to get into crawling position (Mason still can’t crawl yet). Righty has some limitations though. He can’t only lift it about 70 degrees in an upward motion and when he bends his arm he uses his shoulder to assist. Other than that Mason has learned to use his right arm the best way he can.  We are hoping that after the procedure Righty will be able to do even more!

 

Stay tuned for his progress during and after the procedure.