شبکه بازویی یا شبکه عصبی براکیال (brachial plexus)، شبکه‌ای از عصب‌ها هستند که از گردن به شانه و تا دست کشیده می‌شوند. آسیب در این قسمت ممکن است در همه اوقات رخ دهد، اما اکثر آسیب‌های شبکه‌ی بازویی در حین تولد نوزاد رخ می‌دهد، هنگامی‌که شانه نوزاد در کانال زایمان گیر می‌افتد. آسیب شبکه بازویی نوزادان که نام دیگر آن فلج زایمانی است، آسیبی است که در آن شبکه بازویی نوزاد کشیده و موجب آسیب‌های عصبی در آن ناحیه می‌شود.

زایمان یک وضعیت اورژانسی می‌باشد و برای به دنیا آوردن نوزاد به ابزارها و روش‌های کمکی نیاز است. این آسیب همچنین ممکن است بدون گیرافتادگی شانه رخ دهد، در مواردی که زایمان طولانی یا نوزاد درشت باشد، مادر دچار دیابت بارداری شده باشد، به ابزارهای دیگری (مانند فورسپس) برای کمک به زایمان نیاز باشد یا اگر نوزاد در حالت بریچ (بجای سر، باسن یا پاها اول بیرون بیایند) باشد.

شناسایی آسیب شبکه بازویی نوزادان که به آن فلج شبکه‌ی بازویی نوزاد یا فلج زایمان نیز می‌گویند، به اتفاقی در سال 1779 برمی‌گردد که یک نوزاد تازه متولدشده دچار ضعف دست شده بود و چند روز بعد این ضعف از بین رفت. از آن زمان به بعد، متخصصین و کارشناسان توانسته‌اند اطلاعات زیادی در مورد علل و خطرات مرتبط با آسیب شبکه‌ی عصبی براکیال کسب کنند، بااین‌وجود امروزه این مشکل همچنان یکی از رایج‌ترین انواع آسیب‌های حین زایمان است که سالانه هزاران نوزاد دچار آن می‌شوند.

انواع

چند نوع آسیب شبکه بازویی نوزاد در حین زایمان وجود دارد، برخی از آن‌ها شایع‌تر از دیگری هستند و همان‌طور که قبلاً گفته شد، برخی از آن‌ها شدیدتر و جدی‌تر از دیگری هستند.

نوروپراکسی

نوروپراکسی (Neuropraxia)، شایع‌ترین و خفیف‌ترین نوع آسیب شبکه‌ی بازویی در نوزادان است و مشخصه‌ی آن، کشش یا پارگی‌های خفیفی در عصب‌های شبکه‌ی بازویی می‌باشند. ازآنجایی‌که این آسیب خفیف‌ترین آسیب شبکه‌ی بازویی می‌باشد، معمولاً خودبه‌خود در طی چند ماه برطرف خواهد شد. آسیب‌های نوروپراکسی به غشا و دیواره‌ی محافظ عصب صدمه می‌زنند درحالی‌که خود عصب معمولاً آسیبی نمی‌بیند. بااین‌وجود، این نوع آسیب می‌تواند موجب درد و مشکلاتی گردد و تا زمان بهبودی این علائم ادامه خواهند داشت. Symptoms of neuropraxia can include the following:

• muscle weakness in the affected area
• burning, tingling, or numbness in the affected area
• extreme sensitivity and pain in the affected area
• impaired senses

Erb's palsy

Erb's palsy (Erb's palsy) is often used as another name for infantile brachial plexus palsy. This injury occurs when the brachial plexus nerves in the upper arm are damaged. This injury is also known as Orb tear paralysis or brachial plexus tear. The degree of severity of Erb's paralysis is variable and depends on the type and manner of injury. Some of the risks of Erb's palsy include:

• Complete or partial paralysis in the affected arm
• Loss of sensation or motor function in the affected hand
• Reduced strength (to make a fist) and hand numbness
• The affected hand may be bent toward the body or loose.

Depending on the severity of the injury, treatment options for Erb's palsy includes:

• Medication
• Surgery
• Physical treatments and physiotherapy
• Regular massage of the affected arm

Klumpke's palsy

Klumpke's palsy is a type of brachial plexus injury that damages the lower part of the nerve plexus and leads to numbness, loss of sensation, pupil stiffness (Miosis), grip and stiffness The hand is damaged. Limb palsy that affects the hand, wrist, and arm of the affected area and is usually caused by shoulder dystocia (the shoulder is stuck in the pelvis during childbirth). Shoulder dystocia occurs when the baby gets stuck in the mother's pelvis during delivery, which results in the baby being overstretched at birth. Sometimes Klumpke's palsy recovers on its own without treatment, but in severe cases, such as partial paralysis or complete paralysis, medical or surgical treatments may be needed.

Neuroma

Neuroma occurs when scar tissue grows around and throughout the injury, and as a result, puts a lot of pressure on the damaged nerve. This pressure makes it very difficult to transmit the signal from the damaged nerve to the muscles. If the wound and injury is small and mild, the neuroma may disappear by itself. However, if the damage is too large, surgery may be needed to remove the damaged tissue. Neurolysis is a treatment method in which factors (such as hot and cold packs or chemicals such as alcohol) are used on the affected area, and it is the most widely used treatment method for babies with neuroma. According to the International Institute of Health (NIH), more than 50% of patients with brachial plexus injuries are successfully treated with neurologic therapy. src="data:image/svg+xml,%3Csvg%20xmlns='http://www.w3.org/2000/svg'%20viewBox='0%200%20477%20510'%3E%3C/svg%3E" alt="" width="477" height="510" data-lazy-src="https://dreshraghi.com/wp-content/uploads/2020/07/Brachial-3.jpg">

The brachial network is a group of nerve fibers that pass through the spine and extend to the neck and arms. When a baby suffers a brachial plexus injury, the injury can occur in any part of the nerve fibers and its severity can vary depending on the location of the injury and how it occurs. The most important causes of damage to the brachial plexus of babies include stretching and excessive pressure during childbirth and the birth of the baby. In most cases, delivery is performed with pressure and difficulty, which often requires the use of aids such as forceps or vacuum tools. Other causes of this injury are:

• childbirth in breech position (feet being lower than the head). Pregnancy

Even if birth aids are not used, if the doctor applies inappropriate pressure to the child during delivery, the brachial plexus may be damaged. For example, shoulder dystocia occurs when the baby's head comes out but the shoulders are trapped between the mother's pelvis. The doctor may have to pull the baby's shoulders with a lot of pressure to save the baby from suffocation or to prevent any other dangerous situation. This work can lead to rupture and stretching of the baby's brachial plexus nerves. In some cases, the nerve plexus of the baby's arm may be damaged due to contractions. If the delivery is too long and the baby remains in the birth canal for a long time, the contractions of the mother's body can put pressure on the baby's shoulders, resulting in bruises, tears, and in rare cases, fractures. As mentioned before, the symptoms of this injury are:

• Not much reaction is observed on the affected side of the body.
• Limited movement or lack of movement on the affected side.
• Claw-like swelling on the hand. " src="data:image/svg+xml,%3Csvg%20xmlns='http://www.w3.org/2000/svg'%20viewBox='0%200%201044%20510'%3E%3C/svg%3E" alt="" width="1044" height="510" data-lazy-src="https://dreshraghi.com/wp-content/uploads/2020/07/Brachial-4.jpg">

  Diagnosis

  To diagnose brachial plexus damage, the doctor performs a series of tests and evaluations. For example, a motor assessment determines muscle function through a five-point grading system that assesses the infant's ability and inability to use certain specified muscles. A Moro reflex test is also usually done to test for absent reflexes in the affected area. In addition, the doctor will perform a physical examination, including radiography, to identify any fractures (if any) in the clavicle.

  Treatments

  As mentioned earlier, the treatment of this injury depends on the severity of the injury and the type of injury. Although some babies recover naturally and spontaneously or with the help of physical therapy, others may need surgery and medication.

  Medication

  Medication is primarily used to reduce pain and help relax muscles for those who have painful and stiff muscle contractions. If surgery is needed, the child will be given a small amount of anesthetic or mild anesthesia (to prevent pain).

  Surgery

  Surgery for brachial plexus injury in infants may include a procedure called nerve transfer. With the nerve transfer method, the doctor can take a healthy and active nerve from a muscle that is less useful and transfer it to the damaged nerve, this is called a nerve transplant. Although this may not completely cure the brachial plexus injury, studies have shown that many infants who have undergone nerve transfer and grafting recover and are able to use the affected part. Here we must point out that this surgery is usually performed up to three months after the injury; Because most babies with brachial plexus injuries recover within the first trimester or longer, doctors usually wait to see if the injury resolves on its own. Although during this period, physical treatments and regular and daily massage of the affected area are recommended.

  Physiotherapy

  

  Physical medicine and physiotherapy specialists to prevent or reduce joint contractions, maintain or improve muscle tension and endurance, play with toys or do things to strengthen movements and play and increase daily activities to encourage him to attend work (first in the family and then in the community) with children with injuries The arm network works. Physical therapy includes:

  teaching to hold, carry and play with the baby

  Your physiotherapist will give you advice on how to position the baby so that the baby's arms are not dangling when you hold him or carry him in a carrier. The physiotherapist will give you ideas so that you can place the baby on his back or stomach to play without injuring his hand.

  Injury prevention

  Your physiotherapist will explain to you about possible injuries that may cause the baby not to cry when they occur, because if the (injured) hand has little sensation, the child cannot feel pain.

  Active and passive stretches

  Your physical therapist will help you and your child do gentle stretches to increase joint flexibility (joint range of motion) and prevent or delay contractures (muscle stiffness) in the arm.

  Increase endurance and stretching

  Physical therapist, exercises and activities will teach you and your child to maintain or increase hand strength and endurance. Your physical therapist will introduce fun games and activities to help strengthen your child's muscles without requiring them to exercise seriously. As the child grows and improves, he will introduce new exercises and activities that you can do to continue strengthening your child's hand and arm.

  Using Assistive Techniques

  The physiotherapist may use various intervention techniques (assistive techniques) to increase performance and improve muscle movements. Electrical stimulation can be used to mildly stimulate the nerve signal to the muscle and maintain muscle tissue activity. Flexible tape can be used on specific muscle areas to reduce muscle spasms. A modified therapeutic constraint can be used for the healthy hand to force the impaired hand to perform activities. Repetitive exercises for the injured hand, using age-appropriate activities such as finger painting, building a tower (logo game) or picking up and eating small pieces of food are also recommended. Your physical therapist will work with other specialists and doctors to determine the best treatment techniques for your child.

  Improving Developmental Skills

  The physical therapist will help your child learn more advanced motor skills such as lifting weights (baby weights) with the affected arm, sitting while leaning on the affected arm, and walking. He will provide a unique care plan that is designed based on your child's needs.

  Improve health and fitness

  The physical therapist will help you determine the right exercises, diet and communication that will improve your child's health. He works with you and your child so that you can determine the necessary changes so that the child can have a full presence in the family and in society.

  Illness outlook

  Most full-term babies recover from brachial plexus injury. However, the future of children who do not recover within three to six months remains uncertain. Although the studies conducted in this regard have shown that many people make better progress after performing surgery and various treatments and can use their injured hand better, there are still not enough studies and researches to determine a clear progress process. In addition, the more serious the injury, the lower the chance of a full recovery. The success rate in severe injuries is 50%, meaning that patients will have a 50% chance of recovery and full use of their injured hand. For milder brachial plexus injuries that still require surgery, the chance of treatment success will be 100%. Although we must point out that each injury and each situation is unique to the oven. Doctors and specialists work with the patient and will explain to him the chance of recovery according to the injuries and damage caused. Wound infection, although very rare, can occur after surgery. In addition, problems with breathing, damage to blood vessels and ducts, and paralysis are all risks of surgery. Fortunately, all of these risks are very rare and most babies will recover without any problems or injuries. The treated area may be swollen and the baby may experience numbness in the area for a short time after surgery, but this usually resolves within a few weeks after surgery.

  Prevention

  All expectant mothers should receive appropriate care during pregnancy, such as testing for gestational diabetes. Mothers who develop gestational diabetes are likely to give birth to larger babies. The larger the baby, the higher the chance of brachial plexus injury or Erb's palsy during delivery. The position of the mother during childbirth can help improve the baby's movements during the birth process, and the midwife or obstetrician can help her to be in the best position for childbirth. The use of tools to assist in childbirth can also be related to the damage of the baby's brachial plexus. Some pro-family groups recommend that the family examine the delivery environment if the mother knows of risk factors related to brachial plexus injury in the baby. Delivery equipment and environments that have the ability to quickly change for problems that arise during childbirth can prevent or fix shoulder dystocia or shoulder impingement in the mother's pelvis. panel-widget-for-3501-0-1">

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