Physiotherapy is a critical component of rehabilitation for brachial plexus injuries, aiming to restore function, reduce pain, and prevent complications.

Goals of Physiotherapy:

• Maintain range of motion: Prevent stiffness and contractures in the joints of the shoulder, elbow, wrist, and hand.
• Strengthen weakened muscles: Gradually build muscle strength as nerve regeneration occurs.
• Improve sensation: Help with sensory re-education.
• Manage pain: Utilize various techniques to alleviate pain.
• Enhance functional independence: Improve the ability to perform daily activities.

Common Physiotherapy Techniques and Exercises:-

• Passive Range of Motion (PROM) Exercises:
  • The therapist or patient (using the unaffected arm) gently moves the affected limb through its full range of motion. This prevents joint stiffness and maintains flexibility.
  • Examples: Gentle flexion, extension, abduction, and adduction of the shoulder, elbow, wrist, and fingers.
•  Gentle Stretching:
  • Slow, sustained stretches to prevent muscle shortening and maintain joint flexibility.
  • Care is taken not to overstretch or cause pain.
• Active Assisted Range of Motion (AAROM) and Active Range of Motion (AROM) Exercises:
  • As some muscle function returns, the patient actively participates in moving the limb, with assistance if needed.
  • Exercises progress from gravity-assisted movements (e.g., using a re-education board or skate roller) to free exercises against gravity.
• Strengthening Exercises:
  • Isometric exercises: Contractions of muscles without joint movement, often initiated when muscle power is very low.
  • Resisted exercises: As strength improves, resistance is added using dumbbells, resistance bands, or therapist’s hands.
    • Examples: Shoulder shrugs, shoulder rolls, biceps curls, triceps kickbacks, wrist curls, hand squeezes (using a stress ball), external shoulder rotations, finger exercises (e.g., finger taps, touching fingertips to thumb).
  •  Weight-bearing activities: When appropriate, activities that involve bearing weight through the affected limb can help stimulate muscle activation and proprioception.
• Sensory Re-education: Techniques to improve sensation in the affected area, such as different textures, temperature discrimination, and mirror therapy.
• Pain Management:
  • Modalities like electrical stimulation (e.g., TENS) can help reduce pain and stimulate nerve regeneration.
  • Massage to promote circulation and muscle relaxation.
  • Hot/cold therapy.

• Functional Activities and Occupational Therapy:
  • Incorporating exercises into daily tasks to improve practical use of the arm and hand (e.g., dressing, grooming, eating).