BRACHIAL PLEXUS PALSY

A brachial plexus palsy happens when the nerves of the brachial plexus have been damaged during birth. The brachial plexus is a set of nerves that control the muscles of the arm. Palsy means not being able to move muscles in an area (paralysis).

Nerves are soft, tube-like structures inside the body. They contain many small fibers (filaments), like a telephone cable or a thick electrical cord. These small fibers carry signals from the brain to control the muscles. Nerves also carry signals from the skin to the brain. This is how we feel things on our skin.

The nerves of the brachial plexus go out from the spinal cord under the collarbone and into the armpit. From there, they branch out into individual nerves that control the muscles in the shoulder, elbow, wrist and hand.

When nerves in the brachial plexus get damaged, signals cannot travel like usual from the brain to the arm muscles. So some or all of your child’s arm muscles may no longer work. When this affects only the shoulder and elbow muscles, it is called an Erb’s palsy. When it affects all of the muscles of the arm, hand and wrist, this is known as a total plexus palsy.

Brachial Plexus Palsy in Children

Brachial plexus palsies usually happen because of a stretch injury to your child’s head, neck and shoulder. This can happen during birth, especially when the birth is difficult or complex. Sometimes a child’s shoulder will get stuck against the mother’s pelvis. This can result in a stretch injury as your child is being delivered.

The brachial plexus may be injured if a baby's shoulder gets stuck on the mother's pelvis during birth.

In older children, a brachial plexus palsy can occur because of an injury where the neck and shoulder get stretched.

Many children with a brachial plexus palsy recover on their own. But if the condition does not completely resolve within 1 month, it usually has lasting effects. That’s why we encourage you to have your child assessed 1 month after their birth or injury if they have not fully recovered. If treatment is needed, it’s important to begin early and to have ongoing therapy.

Physical and occupational therapy can reduce problems with stiffness or other bone problems that can happen as a result of the injury. Some children need to wear splints to help position their joints while the nerves are recovering. Some need surgery to repair their nerves.

PELVIC PAIN AND WHAT TO DO ABOUT IT

Pelvic pain is pain felt in the lower abdomen, pelvis, or perineum. It has many possible causes and affects up to 20% of the population in the United States, including women and men. Pelvic pain is considered "chronic" when it lasts for more than 6 months. Physical therapists help people experiencing pelvic pain restore strength and flexibility to the muscles and joints in the pelvic region, and reduce their pain.

What Is Pelvic Pain?

Pelvic pain can be caused by:

• Pregnancy and childbirth, which affect pelvic muscles and cause changes to pelvic joints
• Pelvic joint problems from causes other than pregnancy and childbirth
• Muscle weakness or imbalance within the muscles of the pelvic floor, trunk, or pelvis
• Changes in the muscles that control the bowel and bladder
• Tender points in the muscles around the pelvis, abdomen, low back, or groin areas
• Pressure on 1 or more nerves in the pelvis
• Weakness in the muscles of the pelvis and pelvic floor
• Scar tissue after abdominal or pelvic surgery
• Disease
• A shift in the position of the pelvic organs, sometimes known as prolapse

How Does it Feel?

The pain in your lower abdomen and pelvis may vary; some people say it feels like an aching pain; others describe it as a burning, sharp, or stabbing pain, or even pins and needles. In addition, you may have:

• Pain in the hip or buttock.
• Pain in the tailbone or pubic bone.
• Pain in the joints of the pelvis.
• Tender points in the muscles of the abdomen, low back, or buttock region.
• A sensation of heaviness in the pelvic region or even a sensation as if you are sitting on something hard, like a golf ball.

Signs and Symptoms

• Inability to sit for normal periods of time.
• Reduced ability to move your hips or low back.
• Difficulty walking, sleeping, or performing daily activities.
• Pain or numbness in the pelvic region with exercise or recreational activities, such as riding a bike or running.
• Pain during sexual activity.
• Urinary frequency, urgency, or incontinence, or pain during urination.
• Constipation or straining with bowel movements, or pain during bowel movements.
• Difficulty using tampons.
• Imbalance when walking.

How Is It Diagnosed?

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement. The exam may include:

• Pelvic girdle screening.
• Soft tissue assessment.
• Visual inspection of the tissues.
• Reflex testing.
• Sensation testing.
• Internal assessment of pelvic floor muscles.

Your physical therapist also will determine whether you should be referred to a physician to assist in your interdisciplinary plan of care.

How Can a Physical Therapist Help?

Based on the examination results, your physical therapist will design an individualized treatment program to meet your specific needs and goals. Your physical therapist may:

• Show you how to identify the appropriate muscles, such as the pelvic floor, deep abdominals, and diaphragm.
• Educate you on how to use these muscles correctly for activities like exercise, posture correction, getting up from a chair, or squatting to pick up a child or pick something up from the floor.
• Teach you exercises to stretch and strengthen the affected muscles and retrain them, so they work together normally.
• Teach you techniques to improve blood flow and tissue function in the pelvic area.
• Teach you appropriate pelvic floor muscle exercises.

 Depending on your symptoms and level of discomfort, your physical therapist may decide to use biofeedback to help make you aware of how your pelvic floor muscles work, and how you can control them better. Your physical therapist may attach electrodes to the area to measure your muscle activity as it displays on a monitor, and will work with you to help you understand and change those readings. Your physical therapist also may use gentle electrical stimulation to improve your awareness of your muscles.