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Sweden BPI Specialists/Clinics
Tomas Hultgren, M.D.
Christina Strömbeck, M.D.
Response to UBPN questionnaire:
NOTE: Only questions answered are included here
When was your Brachial Plexus Injury Clinic established?
1983
Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including
physical/occupational therapists, if any.
Hand surgery, Neuropediatrics, Radiology, Neurophysiology, Pediatric Habilitation, Rehabilitation, Physiotherapy, Occupational Therapy.
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):
850
Number of children (Trauma or other brachial plexus injuries):
20
Number of adults (Obstetrical brachial plexus injuries):
100
Number of adults (Trauma or other brachial plexus injuries):
350
State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in children.
Physiotherapy with gentle range of motion exercises performed by the parents should start as soon as possible to avoid contractures, in particular the internal rotation contracture of the shoulder and the flexion contracture of the elbow. The child will see the physiotherapist once every other month during the first year and further on 2-6 times a year depending on the severity of the injury.
If the paralysis persists after 2 months the child should be seen by a neuropaediatrician. If there is no improvement in a complete plexus injury after 2 months and in an upper plexus injury after 3-6 months the child should be seen by a surgeon to decide if there is indication for microsurgical reconstruction. Children with total injuries are operated at the age of 3 months whenever possible and upper injuries at the age of 6-9 months if the improvement is unsatisfactory.
Electromyography (EMG) can be used to explore whether there is a regeneration process of the nerve fibers (reinnervation potentials) or if the damage is permanent (denervation potentials). Prior to microsurgical reconstruction, CT or MRI myelography of the spinal cord can be performed to help identify root avulsions of nerves.
Secondary surgical procedures are frequently required. These are procedures which deal with tendon, muscle, bone and joint sturctures for correction of contractures or improvement of power, mobility and posture.
Most commonly these procedures involve the correction of rotation contracture of the shoulder. A large proportion of the children with rotation
contracture also exhibit subluxation or luxation of the shoulder joint which needs to be addressed surgically.
State your philosophy regarding evaluation, referral and treatment of trauma or other brachial plexus injuries in children and adults.
Our aim is to explore and repair traumatic brachial plexus injuries within 2-3 weeks after the injury. Preoperative evaluation is based on
clinical, radiological and neurophysiological examinations.
State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in adults.
We encourage the referral of adult patients with residual impairment of limb
function as a result of an Obstetrical Brachial Plexus injury, to us, for evaluation. Occasionally, even in adults, limb function can be improved by secondary surgical interventions.
State your philosophy regarding pain management and brachial plexus injuries.
Severe pain commonly occurs in traumatic lesions of the Brachial Plexus.
All of these patients are referred to our pain specialists at the anaesthesiological dept., for earliest possible pharmacological management of pain problems. Occasionally neurosurgical procedures, such as implantation of electrostimulation devices are required.
Indicate research efforts (include dates please) conducted by you specific to brachial plexus injuries.
Ongoing studies:
- All patients who pass through our unit are included in an ongoing program of follow up studies, including among other things:
5- & 10-year follow up with mobility & motor-function tests, neurophysiological studies and questionnaires.
- A prospective study of secondary shoulder surgery in Obstetrical Brachial Plexus injuries.
- A long-term follow-up study of shoulder joint development in Obstetrical Brachial Plexus injuries.
- A number of basic scientific studies are conducted in collaboration with a neuromuscular research group.
Indicate any other facts that you feel would help families and individuals understand your practice.
Information days are arranged 3-4 times annually, for patients and their families, as well as for for doctors & other medical staff, who encounter patients with
Brachial Plexus injuries in their work
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