Erbs Palsy — Transplantation of Nerve: treatment in the Best Hospitals in the World
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Department of Adult and Pediatric Traumatology, Orthopedic Surgery, Hand and Foot Surgery
The Department of Adult and Pediatric Traumatology, Orthopedic Surgery, Hand and Foot Surgery offers the full range of modern services to the patients with musculoskeletal diseases and injuries. The key areas of specialization include conservative and surgical treatment of injuries and degenerative changes in the limbs, joints, pelvis and spine. The department is certified by the German Trauma Society (DGU) and has an SAV certificate, which indicates the excellent achievements of the medical facility in the treatment of injuries of any severity. The department performs most surgical interventions using minimally invasive and endoscopic surgical techniques, thanks to which the patients can regain their mobility and return to their usual daily life in the shortest possible time. The department's experienced surgeons perform more than 6,000 operations annually, including particularly complex ones. About 3,000 inpatients and more than 20,000 outpatients receive medical care here every year. The department has 90 beds.
Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery
The Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery offers the full range of services in these fields. The department performs reconstructive plastic surgery aimed at repairing defects after injuries, cancer, and infectious diseases. For patients who wish to improve their appearance without any clinical indications, aesthetic plastic surgery services are available, including facelift, otoplasty, rhinoplasty, body lift, breast augmentation, and anti-aging procedures with Botox and fillers. The department's surgeons also successfully cope with treating hand diseases. Medical care is provided by a team of 17 highly qualified surgeons who daily perform surgical interventions in two state-of-the-art operating rooms. With appropriate indications, outpatient surgery may be performed. When performing surgery, the department's specialists use innovative techniques to achieve excellent therapeutic and aesthetic results.
Department of Adult and Pediatric Trauma, Hand and Reconstructive Surgery
The Department of Adult and Pediatric Trauma, Hand and Reconstructive Surgery offers the full diagnostic and therapeutic service range in the fields of its specialization. In addition to medical care for patients with injuries of varying severity, the department specializes in knee surgery, surgical treatment of the hip joint and pelvis, surgery on the spine, shoulder and elbow joints, foot and ankle joints, sports traumatology, purulent surgery, etc. The department's scope of tasks is complemented by pediatric traumatology, surgical oncology, geriatric traumatology, as well as the treatment of patients with polytrauma. With the use of the very latest methods of osteosynthesis, modern replacement surgical techniques and long experience in proven surgical techniques, the department's specialists ensure optimal treatment results.
Department of Traumatology, Hand Surgery, Plastic and Reconstructive Surgery
The Department of Traumatology, Hand Surgery, Plastic and Reconstructive Surgery covers the whole range of services in these focuses. The department specializes in joint replacement, treatment of tumors of the musculoskeletal system, endoscopic treatment methods for spinal injuries, arthroscopic treatment of joints, etc. The department is also a recognized Center for Sports Orthopedics.
Department of Adult and Pediatric Orthopedics, Trauma Surgery, Foot Surgery
The Department of Adult and Pediatric Orthopedics, Trauma Surgery, Foot Surgery offers the full range of diagnostics, conservative and surgical treatment of musculoskeletal diseases and injuries. The department is a certified Endoprosthetics Center – more than 1,000 primary joint replacement surgeries are performed here annually. The surgeons of the Endoprosthetics Center also specialize in particularly complex clinical cases and revision procedures for the replacement of previously implanted artificial joints. In addition, the department has the status of the interregional Trauma Center certified in accordance with the standards of the German Trauma Society. The department has also been awarded a Certificate of Excellence from the German Orthopedic Foot and Ankle Society (DAF) in the field of foot surgery. A separate area of clinical activity is the treatment of diseases, injuries and congenital malformations of the musculoskeletal system in children. Depending on the severity of the clinical case, both conservative and surgical techniques are used in the treatment of orthopedic pathologies in children. The department's medical team prefers sparing low-traumatic surgery, while open operations are performed only if other therapeutic options are ineffective.
Department of Plastic, Aesthetic and Reconstructive Surgery, Adult and Pediatric Hand Surgery
The Department of Plastic, Aesthetic and Reconstructive Surgery, Adult and Pediatric Hand Surgery offers the full range of services in the areas of its specialization. The department performs aesthetic plastic interventions to correct the appearance, reconstructive plastic interventions to restore deformed parts of the body and their functions after injuries, burns, cancer, etc. The department has unique experience in performing surgical interventions for hand diseases, injuries and malformations, including in children. In addition, the spectrum is complemented by replantation surgery (around the clock). All operations are performed with the use of innovative microsurgical, laser and endoscopic techniques. Medical services comply with the international standards and are adapted to the particular clinical case of each patient. More than 1,000 patients receive inpatient care in the department every year, and about 5,000 patients visit the medical facility for outpatient consultations. The department performs more than 2,500 surgical interventions every year. Plastic surgeons apply all their experience and professional skills to give patients the appearance of their dreams and make it as natural as possible.
Department of Trauma, Hand and Reconstructive Surgery
The Department of Trauma, Hand and Reconstructive Surgery offers the full range of surgical treatment and reconstruction for injuries and lesions of the musculoskeletal system. The department specializes in severe pelvic and spinal injuries, inflammation and bone tissue tumors, treatment of life-threatening polytrauma, as well as the treatment of elderly patients. Also, the department has a special experience in the treatment of knee and shoulder injuries.
Department of Orthopedics and Traumatology
According to the Focus magazine, the Department of Orthopedics and Traumatology ranks among the top German departments specializing in joint replacement surgery! The department specializes in the diagnostics and treatment of all diseases and injuries of the musculoskeletal system. The therapeutic options include both conservative and surgical treatments. The department has 5 modern operating rooms, which meet stringent hygienic standards and a high technological level (for example, 2D and 3D X-rays, navigation systems, surgical microscopes, etc.). Also, it is possible to perform operations on an outpatient basis.
Department of Plastic, Burn Surgery and Hand Surgery
The Department of Plastic, Burn Surgery and Hand Surgery offers the full range of services in these medical fields. The specialization covers reconstructive microsurgery, plastic and reconstructive surgery of the breast, postbariatric surgery, planned and emergency hand surgery. The clinical practice is based on the use of the very latest surgical techniques, which guarantee excellent functional and aesthetic results.
Department of Orthopedics and Traumatology
According to the Focus magazine, the Department of Orthopedics and Traumatology ranks among the top German medical facilities specializing in the treatment of injuries of any severity! The department offers the full range of diagnostic and therapeutic services to patients with diseases and injuries of the musculoskeletal system. The department has been certified by the German Society of Traumatology as a supra-regional Trauma Center. In addition, the medical institution is a certified Center for Gerontological Traumatology, the Center for Arthroscopy and Joint Surgery.
Department of Adult and Pediatric Traumatology, Hand Surgery
The Department of Adult and Pediatric Traumatology, Hand Surgery offers the full range of diagnostics and treatment of injuries of any severity. The specialists of the department have outstanding experience in the treatment of multiple injuries. If necessary, all the necessary doctors from the related fields will be involved in the treatment process. In addition, the department’s competence allows to perform all modern osteosynthesis procedures, including minimally invasive arthroscopic procedures, as well as shoulder, hip and knee replacement surgery.
Department of Adult and Pediatric Trauma, Hand, Reconstructive Surgery
The Department of Adult and Pediatric Trauma, Hand, Reconstructive Surgery offers all modern surgical interventions in these medical fields. The department specializes in the treatment of patients with polytrauma, pelvic surgery, endoprosthetics, cancer, reconstructive surgery and hand surgery. The department has 62 beds for inpatient treatment and 3 high-tech operating rooms for both planned and emergency operations. The prestigious certificates of the Interregional Trauma Center of the German Society of Traumatology and the EndoCert certificate testify to the outstanding quality of medical services.
Department of Adult and Pediatric Plastic Surgery, Hand Surgery
The University Hospital Rechts der Isar Munich was founded in 1834. It combines long traditions with the very latest advances in modern medicine. The medical facility includes 33 specialized departments and 20 interdisciplinary centers, where patients can receive top-class medical care in all medical fields. The hospital annually admits more than 65,000 inpatients for diagnostics and treatment, and about 250,000 outpatients receive effective medical care. The hospital also performs more than 40,000 surgical procedures every year, and about 2,100 babies are born here annually.
Department of Adult and Pediatric Traumatology, Hand and Reconstructive Surgery
According to Focus magazine, the Department of Adult and Pediatric Traumatology, Hand and Reconstructive Surgery ranks among the top German medical facilities specializing in the treatment of injuries! The department offers the full range of treatment for patients injured due to an accident, as well as the treatment of all musculoskeletal diseases and reconstructive interventions. The clinical practice is based on the use of only the most modern therapeutic techniques, adapted to the individual needs of each patient. The priority goal of the entire medical team of the department is the best possible recovery of the patient’s mobility and the assurance of a high quality of life. The department is the Interregional Level I Maximum Care Trauma Center. It performs more than 3,600 inpatient and about 800 outpatient interventions annually.
Department of Adult and Pediatric Orthopedics and Traumatology
According to the Focus magazine, the Department of Adult and Pediatric Orthopedics and Traumatology ranks among the top German orthopedic hospitals in 2019! The department offers the diagnostics and treatment of all acute and chronic diseases and injuries of the musculoskeletal system. At the same time, it uses the very latest methods, for example, minimally invasive and computerized surgical, as well as innovative therapeutic techniques. These include the application of innovative implants, growth promoters or stem cells in the restoration of bone and cartilage tissues. Particular attention is paid to joint replacement surgery.
Department of Adult and Pediatric Trauma Surgery, Hand Surgery, Reconstructive Surgery
The Department of Adult and Pediatric Trauma Surgery, Hand Surgery, Reconstructive Surgery offers conservative and surgical treatment of all injuries of the musculoskeletal system. The spectrum is complemented by sports medicine and the treatment of injuries of all degrees of severity after transport, domestic, sports and industrial accidents. The department specializes in various types of osteosynthesis for the treatment of bone fractures, as well as in the very latest arthroscopic procedures for ligament and joint reconstruction, meniscus surgery, as well as cartilage tissue replacement operations in large joints. The tasks of the department’s doctors include joint replacement surgery, in particular, knee, hip, ankle, shoulder, elbow, wrist and finger joints.
Erb's palsy is one of the most common birth injuries. It is an injury to the brachial plexus, which is formed from the branches of 5-8 cervical spinal nerves and the first thoracic nerve. The brachial plexus provides mobility for almost all the muscles of the upper limb. Erb's palsy is caused by a rupture of the superior trunk of the brachial plexus, which includes the 5th and 6th cervical spinal nerves. Doctors in developed countries successfully treat the disease with nerve grafting.
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The most effective treatment is a nerve transplant. Conservative therapy and rehabilitation involve physiotherapy, therapeutic exercises, botulinum toxin injections, occupational therapy, and other methods.
You can undergo your treatment at the Municipal Hospital Karlsruhe, the University Hospital of Ludwig Maximilian University of Munich, or the University Hospital Frankfurt am Main.
The specialists from the Booking Health company will help you to choose a hospital and organize your trip. You will receive modern treatment at a favorable cost. Your treatment will also be comfortable as you will be accompanied by an interpreter at the hospital, and a personal coordinator will constantly be in touch with any questions that may arise.
Diagnostics
The diagnosis is established by clinical methods. A history includes information about a birth injury. Symptoms are the following:
- the waiter's tip deformity is when the abducted arm hangs down, the shoulder and forearm are turned inward, and the palm is directed outward (a classic sign of Erb's palsy);
- shoulder muscle atrophy;
- the inability to bend the elbow;
- no Moro reflex on the side of the lesion;
- phrenic nerve paralysis may occur, so half of the diaphragm does not move;
- loss of skin sensitivity on the outer surface of the shoulder may also occur.
Instrumental diagnostics are not usually required to confirm Erb's palsy. An MRI scan can be performed if it is necessary to exclude other causes of brachial plexus dysfunction, for example, tumors. X-rays are taken to rule out bone fractures. Muscle strength is assessed using electromyography. Nerve conduction measurement, the time it takes for an electrical impulse to travel along a nerve, can be used as well. The spinal cord can be examined using computed tomography wherever required.
Conservative treatment
Treatment of Erb's palsy abroad begins at a very early age, as soon as possible after the birth of a child. Conservative therapy helps relieve spasm, ensure normal muscle development, and improve limb mobility over time. This therapy is always carried out, but it is an addition to surgery in the case of severe paralysis, and it can be used as a stand-alone method in mild cases.
Doctors use the following methods for conservative treatment and neurorehabilitation for their patients:
- early immobilization followed by passive and active exercises;
- hydrotherapy;
- physiotherapy;
- dry immersion (weightlessness effects);
- positioning therapy;
- botulinum toxin injections to eliminate muscle contractures;
- therapeutic exercises;
- occupational therapy;
- psychological and pedagogical correction.
Surgical treatment
The following two types of operations can be used to treat Erb's palsy:
- nerve decompression;
- transplantation of nerves.
The best results can be provided with a nerve transplant procedure. Doctors take one or more nerves from other parts of the body and restore the trunk of the brachial plexus with their help. As a result, nerve impulses can again pass through this area, and the mobility of the limb improves. The operation restores forearm bending and shoulder abduction.
Doctors can use different donor nerves for transplantation. For example, these may be:
- the intercostal nerves;
- the long thoracic nerve;
- the phrenic nerve;
- the posterior thoracic nerve;
- the spinal accessory nerve.
When using intercostal nerves, doctors take two or three of them, since each contains no more than 500 motor fibers. In Western countries, the operation to connect the phrenic nerve to the musculocutaneous nerve has become widespread.
You are welcome to use the Booking Health service to undergo your treatment in one of the developed countries. Our website offers the best clinics abroad. You can find the prices, compare the cost of services provided by the best medical centers, and make your treatment appointment right away at the best price. Our specialists will help you to choose the most suitable hospitals and organize your trip.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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