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Is surgery essential to correct brachial palsy?

Q: My 2 years old daughter has brachial palsy since birth. Now there is an improvement in the condition, but some movements have not been restored yet. There is a slight bend in the joint of the left arm, which is not as normal as the right hand. The doctor suggested nerve graft / tendon transfer but the occupational therapist said only exercises and therapy have to be given and there is no need for surgery. What should we do now? Please suggest.

A:If as a parent, you find significant improvement in your child’s brachial plexus injury, then let the exercise and time play its major role. Regarding the bent arm, please specify at which level is the bend (movement restricted) e.g. elbow, wrist, torsion around forearm. If a stage comes, where no improvement is visible for weeks then NCV (Nerve Conduction Velocity) test is required to determine the extent of insult to the nerve; before planning for any surgery. Does the child use any splint or any specific positioning is done at the time of sleep? Most of the children show very good improvement with occupational therapy provided your inputs are also there as prescribed by your therapist as home management.

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