Children with brachial plexus and peripheral nerve injuries receive care from a multidisciplinary team of experts who help minimize and correct these injuries in the Peripheral Nerve Clinic at Johns Hopkins All Children's Hospital in St. Petersburg, Florida.

Why Choose Johns Hopkins All Children’s

A brachial plexus injury affects the network of nerves that sends signals from the spine to the shoulder, arm, and hand, and can occur during the birth process. These injuries most often occur during delivery (generally in babies greater than 9 pounds) when the shoulder is stretched during passage through the birth canal.

The clinic at Johns Hopkins All Children’s is run by the world-renowned peripheral nerve neurosurgeon Allan Belzberg, M.D., a professor of neurosurgery at Johns Hopkins University; Lee Phillips M.D., pediatric orthopedic surgeon; and Jordan Halsey, M.D., pediatric plastic surgeon.

Diagnosis begins with a comprehensive physical exam including medical and developmental history and imaging. We coordinate care from a team of specialists, including those from neurosurgery, orthopaedics, plastic surgery, pediatric rehabilitative medicine, physical and occupational therapy and other specialties as needed.

Diagnosis and testing

• Visit with your pediatrician for a comprehensive physical exam. Your pediatrician will determine if a referral to a specialist is needed.
• Diagnosis involves the medical history, developmental history, neurological exam and physical exam.
• Diagnostic tests such as magnetic resonance imaging (MRI) of the brachial plexus and/or cervical spine and electromyogram (EMG) to assess muscle contraction may be used.

What to Expect

• Your child’s first visit typically consists of a consultation/evaluation by neurosurgery, orthopaedics, plastic surgery, and occupational therapy team members.
• After the consultation, the brachial plexus team will plan the best treatment for your child and will work with your family to implement this plan.

Treatment

Some patients will recover spontaneously or at least improve significantly within a few months. For our patients who need further treatment:

• Nonsurgical treatments, including physical therapy, may be used to promote nerve recovery, to strengthen muscles and to improve range of motion.
• Surgical treatments include: Surgical exploration, neurolysis (releasing nerve from the scar), nerve grafting (using a healthy nerve to bridge a nerve gap) and nerve transfers (using working nerves to stimulate nerves and muscles).

If Your Child Needs Surgery

• If your child is found to be a surgical candidate for repair of their peripheral nerve injury, the patient will be admitted the morning of surgery. After surgery, most of the children will be admitted to the general pediatric neurosurgical floor for 24-48 hours of observation and post-operative pain control.
• Post-operatively, most children go home on over-the-counter pain reliever as needed for discomfort.
• We will see the child in post-operative clinic about two weeks after surgery to make sure he or she is healing appropriately.