Primary Goals
The main goals of treatment are to improve muscle strength and sensation and to alleviate muscle and joint contractures (which cause later deformities) in the arm. Specific goals are to:
- Increase shoulder abduction to greater than 90 degrees
- Correct internal rotation of arm
- Increase flexion and extension against resistance in elbow
- Increase flexion and extension against resistance in wrist and fingers
- Improve sensation in the arm and hand
- Prevent deformities of the arm and hand
Specific Treatment Areas
In children with Erb's palsy (upper brachial plexus injury), early therapy should focus on the deltoid muscle and the biceps muscle. Even in children who have made a good spontaneous recovery, the weak deltoid muscle and consequent limitation in raising and rotating the shoulder are common persistent disabilities. These children require later orthopaedic surgeries, such as muscle and tendon releases.
When the middle trunk (see Anatomy section) of the brachial plexus is also involved, the triceps muscle is also weak. The middle trunk injury almost always occurs with either upper or total brachial plexus injury, and thus is associated with more severe disabilities (see "Types of Injury" in Background section).
Persistent weakness in the hand and fingers is most difficult to treat, partly because it often reflects a total brachial plexus injury. In the infant whose hand weakness persists beyond 2 months of age, early surgical intervention may be required.
