Brachial Plexus Injury

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Brachial plexus injuries in newborns cause weakness and paralysis in the arms to varying degrees.[1] In most cases, an infant will fully recover, but some may require treatment or may have lifelong symptoms. The most common condition caused by brachial plexus injury is Erb’s palsy.[2]

The Brachial Plexus

The bundle of nerves called the brachial plexus starts at the spinal cord near the neck. The nerves run through the bones of the neck, to the shoulder, and then some run further down the arm, all the way to the fingertips.

The five primary nerves that make up the brachial plexus connect to smaller nerves in the arm and provide sensation and the ability to move the arms. Each of the five nerves in the brachial plexus can potentially be damaged in a brachial plexus injury.

Because each one controls a different part of the arm, symptoms of damage vary by which part of the arm is affected. The extent to which one or more nerves are damaged will affect how severe the resulting symptoms are.[3]

Types of Brachial Plexus Injury

The type of damage caused to the brachial plexus nerves is categorized by severity:

• The least severe type of injury is stretching, also known as neurapraxia. As a child is pulled from the birth canal, the force on their head and shoulder may be enough to stretch the brachial plexus nerves. A little stretching may cause no damage, but more stretching can cause stress to the nerves.
• More severe damage is called a rupture. When the nerves are pulled to the extent that they tear, they are considered ruptured. The most severe type of brachial plexus injury is an avulsion. This occurs when the nerves are pulled so forcefully that they are completely torn away from the spinal cord. Avulsions are challenging to treat and are most likely to cause permanent symptoms.

Causes of Brachial Plexus Injuries

These nerve injuries are ultimately caused by stretching the nerves to an unnatural degree. In adults and children, some type of forceful accident may cause an injury. This could include penetration wounds, gunshot wounds, and falls.

Although these injuries are possible in adults and children, the most common timing of a brachial plexus injury is in childbirth.

Childbirth damage to the brachial plexus can occur in several ways:

• When a baby is being born, and its head and shoulder get stretched apart, for whatever reason, the brachial plexus may become damaged.
• Risk factors include large fetus size, long and difficult labor, and breech birth position.
• Examples of how the damage occurs may include a baby born with its head and neck pulled to the side as the shoulders pass through the birth canal.
• Another example is when the infant’s arms are raised above its head during a breech birth. This can stretch the nerves. Also, it is possible that during a head-first delivery, the infant’s head will be pulled too forcefully, causing stretching and damage.

In some cases, the damage to the brachial plexus nerves during childbirth is considered preventable, and the medical caregiver may be found negligent.

For instance, if a doctor opts not to perform a Cesarean section, it may result in difficult labor and subsequent damage to the nerves. Incorrect use of instruments, like forceps, or simply using too much force on the infant may also be the fault of the doctor or midwife.

Brachial Plexus Palsies

Injury to these nerves causes one of several types of conditions called palsies. The most common is Erb’s palsy, in which the upper arm is affected.

If the nerves that control the lower part of the arm are affected, it is sometimes called Klumpke’s palsy or Klumpke’s paralysis.

In some cases, any type of palsy caused by the brachial plexus damage is called Erb’s palsy or brachial plexus palsy. When all five nerves of the brachial plexus are damaged, it is called global palsy.

Symptoms

Brachial plexus palsies result from damage to the nerves that control the arms. The result is a weakness in the arm, loss of sensation, or even paralysis. In most cases of palsies, the symptoms can be seen right after birth.[4]

These include a lack of movement, or weaker movement, in one arm compared to the other, an arm being bent inwards at an awkward angle, or a weaker grip in one hand. A baby with a brachial plexus palsy will also likely lack the Moro reflex on one side.

Treatment

In the vast majority of cases of Erb’s palsy caused during childbirth, the infant will recover within three to six months and face no lasting effects of the nerve damage.[5]

This is because most palsy cases result from mild damage to the nerves. Most infants recover with time and gentle physical therapy.

Physical therapy promotes the natural healing of the nerves and helps an infant develop more muscle strength in the affected arm. Parents can be guided by a physical therapist and shown how to practice the techniques between sessions. A therapist may use a range of motion exercises and gentle massage.

Surgery

In more severe cases of brachial plexus injury, therapy and time may not be enough to heal the nerves. If an infant shows no improvement by six months, a doctor may recommend surgery to repair the damaged nerves.[6]

A nerve graft can be used to repair those nerves that have been stretched beyond their limits or torn. This involves patching in a donor’s nerve.

In the most extreme cases, in which a nerve has completely torn from the spinal cord, a nerve transfer may be performed. This involves using a donor nerve to completely replace all or part of a damaged brachial plexus nerve.

Donor’s nerves come from another part of the body. Recovering from surgery on nerves takes a long time, and in the case of infant brachial plexus injuries, full recovery may never be possible.

Prognosis

The outlook for most infant brachial plexus injuries is excellent. With just natural healing and physical therapy, most infants will fully recover within three to six months of birth.[7] These babies will likely not have any lasting symptoms of palsy.

However, those with more severe damage will probably have lifelong symptoms, including some degree of weakness or paralysis and diminished sensation in the affected arm.

If you feel that your child’s brachial plexus injury was caused by doctor negligence or wrongdoing, you may have a case. Many parents with children facing lifelong consequences from this kind of palsy sue the hospital or doctor for damages.