Potential new treatment for brachial plexus injury: nerve regeneration

The brachial plexus is a network of nerves located near the neck. In some cases, when the birth of a child is traumatic due to use of excessive traction by the delivering caregiver, these nerves can tear. There are a variety of medical complications and errors that can lead to birth trauma and brachial plexus injuries, including the following:

• Shoulder dystocia: When the baby’s shoulder gets stuck behind the mother’s pelvic bone. This is more likely to occur when there is fetal macrosomia (an abnormally large fetus) or cephalopelvic disproportion (a size mismatch between the fetus’s head and the mother’s pelvis)
• Unusually short or prolonged second stage of labor 
• Abnormal cervical dilation
• Misuse of vacuum extractors or forceps
• Usage of synthetic oxytocin (Pitocin) in labor; this can cause uterine tachysystole (excessive uterine contractions)
• Fetal malpresentation (e.g. breech)

In some cases, brachial plexus injury heals on its own. However, it may lead to a condition known as Erb’s palsy, which can be permanent. Erb’s palsy is characterized by arm weakness or paralysis. Current treatments for this condition include nerve transplants, subscapularis muscle releases, and Latissimus Dorsi tendon transfers. While these treatments may help certain patients, recovery is often limited, and negative side effects are common. Therefore, the search for new ways to treat brachial plexus injuries is an important area of research (1). 

Could nerve regeneration be the answer?

Evan L. Nichols and Cody J. Smith, from the University of Notre Dame, recently published the results of their research on the use of nerve regeneration to treat brachial plexus injury in zebrafish (2).

Early on in development, the dorsal root ganglia (DRG) sensory axons (a type of nerve) enter the spinal cord to connect with neurons that are critical for sensation and function in the hands, arms, and shoulders. However, after brachial plexus injury, they are unable to complete this movement.

The Notre Dame researchers were able to identify a process that could enable regenerating DRG sensory axons to enter the spinal cord. This process involved the use of a chemotherapy treatment, paclitaxel. These nerves were then able to connect with important neurons (2, 3). 

Indeed, the zebrafish studied showed signs of full functional recovery after 48 hours.

In an article for Notre Dame News, Brandi Whampler notes that Nichols and Smith’s findings indicate that “there could be a new path forward for a full behavioral recovery.” 

Moreover, the implications of this research may be fairly broad. Whampler writes that, “Although the study was intended to mimi regeneration after obstetrical brachial plexus injuries, there is potential for it to benefit those who suffer a brachial plexus injury later in life as a result of an accident or trauma” (3).

ABC Law Centers: Help for babies with brachial plexus injuries

In newborns, brachial plexus injuries often stem from birth trauma, which may be caused by the negligent actions of a doctor, nurse, or medical organization. For example, a doctor may ignore signs that a baby is too large to safely fit through the mother’s pelvis, and decide to proceed with a vaginal delivery when a C-section is the safer option (1). If negligence results in Erb’s palsy or another form of permanent harm, it constitutes medical malpractice.  

If your child is affected by brachial plexus injury or Erb’s palsy, please contact the birth trauma attorneys at ABC Law Centers. We have numerous case results, client testimonials, and awards that attest to our success, and we give personal attention to each child and family we work with. Reach out today for a free case evaluation. 

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Sources

1. Erb’s Palsy and Brachial Plexus Injuries in Babies. (n.d.). Retrieved January 22, 2020, from https://www.abclawcenters.com/practice-areas/types-of-birth-injuries/erbs-palsy/ 
2. Nichols, E. L., & Smith, C. J. (2020). Functional Regeneration of the Sensory Root via Axonal Invasion. Cell Reports, 30(1), 9-17.
3. Wampler, B. (2020, January 16). New study identifies potential path forward for brachial plexus injury recovery. Retrieved January 22, 2020, from https://news.nd.edu/news/new-study-identifies-potential-path-forward-for-brachial-plexus-injury-recovery/ 

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