Brachial plexus reconstruction

Every organ and system in our body can sense and move thanks to the peripheral nervous system, which goes from the spine and branches out to hundreds and thousands of neural fibers. The sensation and mobility of the upper limbs, for example, are possible thanks to the activity of a large group of nerves that leave the upper part of the spine and sends its fibers through the neck and the armpit, all through the arm.

This group of the nerve is called the arm plexus or the brachial plexus, and damaging it – which could be caused by several reasons – could cause severe problems in the arm’s mobility, up to complete paralysis. Prof. Shimon Rochkind is one of the senior doctors at the excellence center for neurosurgery at the Herzliya medical center hospital and considered an international expert in the treatment of injuries relating to the peripheral nervous system – with emphasis on brachial plexus injuries.

Neural damage to the brachial plexus

As said, the brachial plexus is a group of nerves stretched from the upper spine to most parts of the upper limb. One of its central spots, a sort of intersection in which all plexus nerves meet, is in the top part of the shoulder, next to the collar bone, exposing these nerves and making them relatively vulnerable.

As known, the body’s nerves are sensitive to pressure, the great force exerted on them directly and external injuries that might severe them partially or completely. In this situation, the sensation and mobility abilities of the organs they control will be damaged, up to paralysis.

Damage of the brachial plexus is considered relatively very common in births, and that’s why it’s also known as obstetric paralysis. This is an injury defined as a pulling injury since it’s caused when pulling the baby’s head out during birth: the neonate’s passage through the narrow cervix might in certain cases exert great pressure of the plexus, up to significant harm to the neural function in the area.

It should be noted that this case isn’t typical for every birth, and occurs at most in 3.6 births out of 1,000 cases.

Different factors increase the risk for obstetric paralysis

• Significant increase in the mother’s weight during pregnancy
• A higher weight of the fetus than normal
• Mother’s diabetes
• Multiple fetuses birth
• Obstetric paralysis in the mother’s previous pregnancies
• Difficult birth
• Fetal stress during birth
• Forceps delivery
• Cesarean section
• Fetal reversal (buttock position).

Although this injury is very common in births, there are other cases where it might occur

• Strong blow to the shoulder area
• The exertion of great pressure on the area
• Gunshot wound or stab with a sharp object
• The strong pull of plexus (during a car accident for example).

With everything relating to brachial plexus injury, the task is considered quite complicated when the injury is during birth.  Because of the fact that this is a newly born infant whose responses aren’t the same as an adult’s, many neurological tests cannot be relied on (like a neural conduction test).

The diagnosis, then, will be done in 3 ways

• Stimulation of the baby’s reflexes and encouraging moving the injured arm
• Clinical diagnosis via various medical classifications (sort of a “movement test”)
• Various imaging tests could locate other injuries (for example collar bone fracture).

At an old age, the diagnosis will be much simpler and done via a row of different neurological tests, in addition to the patient’s own reports. In these ways, the doctor could locate the exact location of the injury, the damaged nerves and the severity of the situation – allowing him to determine the best treatment for that case.

At our private hospital, there is advanced medical equipment, allowing the doctors to perform every test and diagnosis in the best way.   The vast experience of Prof. Rochkind and his staff, alongside the use of the hospital’s sophisticated equipment, ensure that every diagnosis at every age will be performed in the most precise manner.

When is there a need for Brachial plexus reconstruction surgery?

Brachial plexus injury could occur on several levels, starting with minimal reduction in the arm’s mobility and sensation and up to complete paralysis. When the injury is relatively minor, the conservative treatment would be preferred, including physical therapy and rehabilitative treatments of the injured muscles and nerves. If the brachial plexus injury is considered significant and difficult, the only option is to treat it with designated neurosurgery.

Here we’ll note that the decision for the need for surgery will be made usually about 1-2 months after the injury: if throughout this period there was no improvement in the condition, meaning if the body cannot recover naturally and independently, the only choice is brachial plexus reconstruction surgery.

During the surgery, the damaged nerves will be re-sown, to restore their ability to conduct electrical signals from the brain properly and to allow proper function of the arm. If this action isn’t possible, healthy nerves, which would mostly be taken from the shin or an adjacent group of nerves, will be transplanted instead of the damaged nerves. The surgery can be performed today in the minimally invasive method (one of the fields in which the HMC hospital is considered a top leader in Israel), which guarantees faster recovery than the procedure.

Brachial plexus reconstruction surgeries are microsurgical surgeries performed only by doctors who are experts and experienced in treating such an injury. To date, Prof. Rochkind has performed a long line of brachial plexus reconstruction surgeries. Thanks to his high capabilities and the optimal conditions in which the surgery is conducted at the excellence center of the hospital, the success rates of the neurosurgical procedure are considered very high, and the vast majority of patients gain maximal rehabilitation of the plexus nerves.

For consultation and additional information, contact us at +972-9-959-4888 or leave your details and we’ll get back to you as soon as possible.