[Paralysis plexus brachialis--diagnostic and therapeutic protocol].

Traction injuries of the brachial plexus, if obstetrical, are diagnosed immediately upon birth based on clinical features, while the type and the degree of injury are confirmed by neurophysiological examination. In such cases, physical therapy is promptly applied and followed up until the age of three months, when, after consultation with neurosurgeon, either physical therapy is continued or surgery is performed. In traumatic injuries, based on clinical, neurological and neurophysiological findings, necessary surgical or pre- and postoperative physiatric interventions are performed. Timely diagnostics and therapy of brachial plexus injuries, followed by recovery of paralytic muscle motor function, enable motion coordination and prevention of contractures. From 2000-2004, 181 cases of brachial plexus birth trauma and 26 cases of brachial plexus traumatic lesions were diagnosed and treated in our institution. Among patients, there were 107 boys and 74 girls with birth injury of the brachial plexus, and 16 boys and 8 girls with traction injury of the brachial plexus sustained in traffic accident. Physical treatment involved combined thermo-, electro-, and kinesitherapy, with alignment of extremities. Upon completion of any treatment session and clinical and neurophysiological examinations, doctors' consultation determined whether to continue with physical therapy or to perform surgery followed by physical therapy with rehabilitation until achieving the maximal motor recovery. The analysis of results showed that functional and motor recovery was best if therapy was initiated immediately after the obstetrical injury or following the surgery. Therapeutic approach was individualized and depended on the level and degree of lesions. Thus, maximal motor and functional recovery of the injured extremity was achieved, with work therapy and professional orientation of such patients.