Pennsylvania BPI Specialists/Clinics

P. David Adelson, MD, FACS, FAAP


Response to UBPN questionnaire:
NOTE: Only questions answered are included here

When was your Brachial Plexus Injury Clinic established?

1995
Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including physical/occupational therapists, if any.

Neurosurgeon, Neurologist, Hand/ Upper extremity surgeon, Physical and Occupational Therapists, Neurophysiologist, and Social Work.
What do you/your clinic specialize in treating?

  • adult brachial plexus injuries
  • obstetrical brachial plexus injuries
  • trauma or other brachial plexus injuries
Indicate the total number of brachial plexus patients you/your clinic has evaluated since your establishment:

Number of children (Obstetrical brachial plexus injuries):
Approximately 800

Number of children (Trauma or other brachial plexus injuries):
Approximately 100

Number of adults (Obstetrical brachial plexus injuries):
Approximately 25 (Only over past 2 years*)

Number of adults (Trauma or other brachial plexus injuries):
Approximately 50 (Only over past 2 years*)

*Only started seeing adults 2 years ago through the center, prior to that only on an individual basis.
State your clinic philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in children.

  • Initial evaluation by 6 weeks of age
  • PT/ OT following evaluation, at least once a week by therapist, twice a day by family
  • Follow up evaluations at 3, 6, 9 and 12 mos.
  • If no functional recovery or plateau, consider primary surgery.
  • Usually not before 6 mos of age, except when clearly no recovery.
  • Usually not after 12 mos of age, except with proven breakthroughs of plateaus
  • Primary surgery usually 6 to 9 mos of age, not overly aggressive, not overly conservative.
  • EMG, MRI before surgery planned.
  • Continue PT/OT during interim postoperatively
  • Depending on recovery over next 12- 24 mos, consideration for secondary surgery
  • For secondary surgery, do not usually do everything for everyone. Surgery is tailored to the individual needs including neurolysis, contracture release, and/or tendon transfers.
  • Consideration for distal/ forearm tendon transfers after 12 mos of recovery for secondary surgery.
State your clinic philosophy regarding evaluation, referral and treatment of trauma or other brachial plexus injuries in children.

  • Initial evaluation by 2 weeks after injury
  • PT/ OT following evaluation, at least once a week by therapist, twice a day by family
  • EMG, MRI before surgery planned and at least 6 weeks after injury.
  • Follow up evaluations at 6 weeks, 3, 6, 9 and 12 mos depending on recovery.
  • If no functional recovery or plateau, consider primary surgery.
  • Usually not before 3 mos after injury, except when clearly no recovery.
  • Usually not after 12 mos after injury, except with proven breakthroughs of plateaus
  • Primary surgery usually 4- 9 mos after injury.
  • Continue PT/OT during interim
  • Depending on recovery over next 12- 24 mos, consideration for secondary surgery
  • For secondary surgery, do not usually do everything for everyone. Surgery is tailored to the individual needs including neurolysis, contracture release, and/or tendon transfers.
  • Consideration for distal/ forearm tendon transfers after 12 mos of recovery for secondary surgery
State your clinic philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in adults.

  • Initial evaluation upon referral
  • PT/ OT for interim, at least once a week by therapist, twice a day by patient and/ or family
  • Follow up evaluations at 3 and 6 mos.
  • If improvement or continued plateau, consider surgery.
  • EMG, MRI before surgery planned.
  • For surgery, do not usually do everything for everyone. Surgery is tailored to the individual needs including neurolysis, contracture release, and/or tendon transfers.
State your clinic philosophy regarding evaluation, referral and treatment of trauma or other brachial plexus injuries in adults.

  • Initial evaluation by 2 weeks after injury
  • PT/ OT following evaluation, at least once a week by therapist, twice a day by patient and/ or family
  • EMG, MRI before surgery planned and at least 6 weeks after injury.
  • Follow up evaluations at 6 weeks, 3, 6, 9 and 12 mos depending on recovery.
  • If no functional recovery or plateau, consider primary surgery.
  • Usually not before 3 mos after injury, except when clearly no recovery.
  • Usually not after 12 mos after injury, except with proven breakthroughs of plateaus
  • Primary surgery usually 4- 9 mos after injury
State your clinic philosophy regarding pain management and brachial plexus injuries.

Pain is a frequent finding following brachial plexus injuries. We work with our pain management clinic to optimize pain control.
Indicate research efforts (include dates please) conducted by your clinic specific to brachial plexus injuries.

We are interested in the mechanisms by which nerves regrow following nerve grafting and alternate methods of grafting. In addition, we have been studying the etiology of continued dysfunction at the shoulder following the primary surgery and how the secondary surgery is beneficial.
Indicate any other facts that you feel would help families and individuals understand your practice/clinic.

The Children’s Hospital of Pittsburgh and University of Pittsburgh Brachial Plexus and Peripheral Nerve Injury Center through its multidisciplinary, state of the art evaluation and treatment for adults and children with brachial plexus and peripheral nerve injuries delivers the highest in quality of care. Because of its location, it is ideal for those patients and families wishing to seek out a center of excellence for these problems closer to home, facilitating follow up, and more hands on personal care. Though not the most senior of centers, since the center has been around for 7 years, , it is able to provide the highest level of care utilizing state of the art evaluative and surgical techniques with comparable success. In addition, our approach in evaluation and treatment is on an individual by individual basis. Not all patients get all the procedures all the time like some centers. It is very individually driven.
Do you accept any national/governmental payment for services or are you enrolled in any state medicaid plans? Please provide information on these plans and include which states you are enrolled in for medicaid services.

Our Children’s Hospital and physicians are universal providers for Pennsylvania and the surrounding states. The University hospital accepts Medicare and most Medicaid plans as well as Blue Cross/ Blue Shield and UPMC Health Plans.
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