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Nerve injuries in children may occur during birth and they can sometimes be hard to identify. Dr. Krister Freese discusses the symptoms and treatment options of brachial plexus injuries, how to keep an eye out for signs and ways to prevent this type of injury.

Brachial Plexus

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Cheryl Martin (Host): Nerve injuries in children may occur during birth. Coming up, we discuss the symptoms and treatments for a brachial plexus. Welcome to Healing Heroes. PDX the podcast series from the Specialists at Shriner's Hospitals for Children in Portland. I'm Cheryl Martin, Our guest this episode is Pediatric Hand Surgeon Dr. Krister Freese. Welcome Dr.

Dr Krister Freese: Thank you.

Cheryl Martin (Host): First of all, tell us a little bit about yourself and your decision to specialize in being a pediatric hand surgeon?

Dr Krister Freese: Yeah, I think, for me, it's been really nice. I trained in orthopedic surgery and I really enjoyed taking care of children. and during my training I also enjoyed taking care of hand problems. And so it's sort of this nice marriage of the two, pediatric hand surgery is really interesting. We get to take care of really injuries and hand problems all the way from the fingertips to the shoulders. And we also get to take care of a huge variety of different problems. So fracture work problems with muscles and tendons. And hand surgeons also take care of nerve injuries, which is really interesting to me.

Cheryl Martin (Host): Well, that's a perfect segue to the next question. So what is a Brachial Plexus injury?

Dr Krister Freese: Brachial Plexus injuries happen from a variety of different causes.. They can be traumatic, that's more common than adults and kids, they typically happen as the result of a birth injury. The Brachial Plexus is this group of nerves that basically connects your spinal cord, to the peripheral nerves that go into your arm. and when they're injured, you can have a variety of findings. So some kids might lack elbow flexion or shoulder movement, all the way to having a completely flail arm.

Cheryl Martin (Host): And is this different from peripheral nerve injuries?

Dr Krister Freese: It's a type of peripheral nerve injuries. when we think about peripheral nerve injuries in kids, it's commonly from a cut or laceration. So, they break a glass or they, accidentally slip with a knife or something like that, and they cut a nerve or peripheral nerve injuries can also happen as a result of fractures, for instance.

Cheryl Martin (Host): So how common is this type of injury? A brachial plexus injury?

Dr Krister Freese: Fortunately, they're really rare, in the setting of a birth injury. It happens in maybe one per thousand live births and traumatic brachial plexus injuries in kids are even more rarer than that.

Cheryl Martin (Host): So what should a parent look for as signs that this injury has occurred?

Dr Krister Freese: The most common thing is a brand new baby who's not moving their elbow or their shoulder. Most babies that are born with a brachial plexus injury will move their hand and their wrist, but they might not move their elbow and shoulder. In more severe injuries, they might not move any part of the upper extremity.

Cheryl Martin (Host): So what can a parent expect when they bring their child in to have something like this looked at?

Dr Krister Freese: Usually we wanna see kids kind of as early as possible. And so we'll try to see new babies, at the one month or two month mark after they're born. And we really wanna just follow them along. Fortunately, many of these injuries will recover on their own. Sometimes a nerve is just stretch. And that nerve falls asleep temporarily. if the injury is more severe, the nerve might not recover, but we really want to develop a relationship with the family, see the new baby and follow them along with examinations every month or so. And so that's one of the reasons that we like to see families really early.

Cheryl Martin (Host): And how do you treat the injuries? And also when is surgery needed?

Dr Krister Freese: Surgery's needed usually when a brachial plexus injury is not recovering. So for the patients who have an arm that, the hand is not working in, we will typically do surgery around three months of age, and that usually means that we're gonna do some nerve surgery, where we would either borrow nerves that are expendable to sort of reinnovate the nerves that we really need, or sometimes we will actually remove the segment of damaged nerve. And replace that with a nerve graft. In kids who have elbows and shoulders that are not moving, we can wait longer. so usually up to six to nine months of age when we might consider surgical intervention.

Cheryl Martin (Host): And if there is surgery, how long is recovery from the surgery?

Dr Krister Freese: The patients do really well in the short term, so they recover from a pain standpoint really quickly. but nerves themselves take a long time to recover. They recover at about an inch a month from wherever the injury is, to where they go into the muscle. So if you're trying to get a nerve signal, which is like electrical signal from the neck down to biceps, for instance, in the upper arm, it could take, six, nine months, maybe even a year to get recovery, which can be really frustrating for parents to wait and wait and wait. But also exciting once we see that muscle start to work again.

Cheryl Martin (Host): So what's the outlook doctor for children who have had a brachial plexus injury? Can parents expect them to be restored? Let's say 100%?

Dr Krister Freese: Not usually. We think of, doing nerve surgery as certainly better than not intervening. but. The child's unlikely to have, a complete recovery, so that there's no difference from side to side. our goal is trying to make the child as functional as possible, as they go into adulthood. And so, recovery probably isn't 100%. But usually a functional recovery can be expected.

Cheryl Martin (Host): So the child can have a normal life?

Dr Krister Freese: Yeah. And do the things that they want to do.

Cheryl Martin (Host): Do you see this injury, let's say, as a result of children playing contact sports?

Dr Krister Freese: It can happen that way. Fortunately, that's fairly rare.

Cheryl Martin (Host): Anything else you want to add about Brachial Plexus?

Dr Krister Freese: Well, I think the one thing that I would say about Brachial Plexus injuries and all nerve injuries is that patients should be seen as soon as possible. Especially if you have a cut nerve, we wanna repair that really within a week or so of injury. Nerves recover very slowly and if muscle does not have nerve signal, the muscle will eventually go away and it doesn't come back. And so we kind of say time is muscle, when we're talking about nerve injuries. And so we wanna take care of patients really as soon as we possibly can, as soon as the injury's been identified.

Cheryl Martin (Host): Dr. Krister Freese. Thanks so much for being on and just for sharing your expertise on this topic For more information, you can check out our website at shrinersportland.org. That's shrinersportland.org. And that concludes this episode of Healing Heroes PDX with Shriner's Hospitals for Children Portland. To listen to more podcast episodes, head on over to our website at portlandshrinershospital.org, and thanks for listening.

About the Speaker

Krister Freese, M.D.

Krister Freese, M.D., is a Pacific Northwest native from Puyallup, Washington. He received his undergraduate degree from Pacific Lutheran University and went on to obtain his medical doctorate at the University of Washington. He subsequently completed his orthopedic residency at the University of Hawaii. He completed two fellowships, one in pediatric orthopedic surgery and a second in hand and upper extremity surgery in 2016, at the University of Colorado.

Learn more about Krister Freese, M.D.

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