Brachial Plexus Injury

Overview

A brachial plexus injury is a type of nerve damage that affects the network of nerves controlling the muscles in the shoulder, arm, and hand. This injury often happens during difficult births, especially in large babies or when the baby is delivered in a breech position (feet-first). It occurs in about 0.5 to 2 out of every 1,000 births.

  • Erb Palsy: 
    • This is the most common type, affecting the upper nerves in the brachial plexus (C5-C6). 
    • Babies with Erb palsy have trouble moving their shoulder and may hold their arm close to their body, with the palm facing backward.
  • Whole Brachial Plexus Injury: 
    • This affects all the nerves in the brachial plexus and happens in about 10% of cases. 
    • It can lead to more severe problems with movement in the arm and hand.
  • Klumpke Paralysis: 
    • This is a rare injury affecting the lower nerves (C7-T1), leading to weakness in the hand and fingers. The grasp reflex may be absent.

Related Injuries:
Brachial plexus injuries can sometimes occur alongside other injuries, such as:

  • Broken Collarbone (10%)
  • Broken Upper Arm Bone (10%)
  • Partial Dislocation of the Spine (5%)
  • Spinal Cord Injury (5-10%)
  • Facial Nerve Damage (10-20%)

Recovery

Most babies with brachial plexus injuries recover well, with many showing significant improvement in the first few months:

  • 88% recover by 4 months.
  • 92% recover by 12 months.
  • 93% recover by 48 months.

Long-Term Effects

In some cases, there may be long-term issues such as:

  • Bone deformities
  • Muscle weakness
  • Joint stiffness
  • Possible slower growth of the affected arm

Diagnosis

To diagnose a brachial plexus injury, doctors may:

  • Examine the shoulder and arm for any signs of injury.
  • Check the chest to see if the phrenic nerve, which controls breathing, is also affected.
  • Use MRI scans to look at the nerves without needing surgery or sedation. This can help determine the severity of the injury.
  • Perform Electromyography (EMG) and Nerve Conduction Studies to see how well the nerves and muscles are working.

Treatment Options

Initial Care:

  • Immobilization: 
    • The baby’s arm may be gently immobilized across the abdomen for the first week to prevent further injury.
  • Physical Therapy: 
    • After the first week, gentle exercises will help maintain the range of motion in the joints.
  • Supportive Devices: 
    • Wrist splints may be used to support the arm.

Surgery:

  • Timing: 
    • Surgery is usually most effective if done within the first year of life.
  • When Needed: 
    • If there is no improvement in the upper nerves by 3 months, surgery may be considered to repair the nerves.
  • Risks: 
    • Surgery carries risks such as infection and poor outcomes, especially in severe cases where the nerves are completely torn from the spinal cord.

Other Procedures:

  • Tendon Transfers:
    • In some cases, transferring tendons from one muscle to another can improve function, particularly in the shoulder for babies with Erb palsy.

Brachial plexus injuries, while challenging, often have a good prognosis with proper care and timely intervention. At Gertrude’s Children’s Hospital, we offer comprehensive care from diagnosis through to recovery, using the latest technology and treatments to ensure the best possible outcomes for your child.

Patient Success Stories

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Brachial Plexus Injury. Here’s why families trust us:

“Our baby was diagnosed with Brachial Plexus Injury, and we were so worried about their health. But the team at Gertrude's Children's Hospital was amazing. They explained everything to us and provided the best possible care for our baby.”

Sarahparent of a baby with Brachial Plexus Injury

Brachial Plexus Injury

If you notice any unusual symptoms in your baby, such as those listed above, contact your pediatrician immediately. Early detection and treatment are crucial for the best outcomes.

While not all birth injuries can be prevented, certain risk factors can be managed with proper prenatal care, careful monitoring during labor, and skilled medical intervention when necessary.

The prognosis depends on the type and severity of the injury. Many babies recover fully with appropriate treatment, while others may require ongoing care. Our team at Gertrude's Children's Hospital will provide you with detailed information about your baby’s condition and expected outcomes.

Nerve damage may be treated with physical therapy, occupational therapy, and in some cases, surgery. Early intervention is key to improving outcomes.

Surgery is only recommended when necessary and is performed by experienced pediatric surgeons. Your baby’s safety and well-being are our top priorities, and we will discuss all potential risks and benefits with you before proceeding.

Following the treatment plan provided by your healthcare team is essential. This may include exercises, feeding practices, and regular follow-up visits. Our team will guide you on how to care for your baby at home and provide resources for additional support.

Contact Us

If you have concerns about your newborn’s health or if your baby has been diagnosed with this birth injury, we encourage you to schedule an appointment with one of our specialists at Gertrude’s Children’s Hospital. Early intervention is crucial, and our team is here to help.

Contact us today to learn more about our Brachial Plexus Injury treatment options.

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