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Brachial plexus injuries are caused by damage to the nerves that control movement and provide sensation in the arms. They most often occur in newborns during labor and delivery, and the prognosis is generally good. Most infants recover entirely, but some will have lasting symptoms.
Brachial Plexus Injuries
The brachial plexus is the set of 5 major nerve branches that link the spinal cord to the small nerves that control shoulders, arms, wrists, and hands. These nerves are responsible for sensations and muscle movements in those areas.
Newborns may have brachial plexus injuries because of how they came out of the womb. Any difficulty during delivery that causes the infant’s head, shoulder, or neck to be stretched or pulled can damage the nerves.
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This stretching motion, if severe enough, can cause damage to the nerves from the spinal cord that runs through the neck and down the arm.
Damage to the brachial plexus is mild and causes minimal symptoms in most cases. In some babies, the damage is more severe. This may include tears and rips or avulsion when a nerve or multiple nerves tear completely away from the spinal cord.
The dysfunction will vary depending on the nerve affected. Each of the five nerve bundles controls different parts of the arm. A child may have symptoms in the upper arm, lower arm, wrist, or hand.
Symptoms of brachial plexus injury include loss of sensation, weakness, numbness, and partial or complete paralysis of muscles in any part of the arm.
The Importance of Early Treatment
Mild cases may not require any treatment or may benefit from physical therapy. More severe injuries, on the other hand, may not heal without treatment.
The most common approach for treating injuries severe enough to cause tearing or avulsion is surgery to repair the damage. A donor nerve can be grafted onto the damaged portion of a brachial plexus nerve or used to reattach a nerve that separated from the spinal cord.
A baby has the best prognosis when doctors diagnose and begin treating brachial plexus injuries early. Early interventions give a child the best chance of healing, having minimal lasting symptoms, and having the best outcome.
If symptoms are mild, there may be no treatment beyond gentle physical therapy, and most infants will recover entirely by three to six months of age.
If surgery is needed, it should be done as early as possible, before the damage and consequences become irreversible. By the age of three to six months, an infant may be evaluated for surgery if necessary. This gives doctors a chance to see if the baby will heal naturally and avoid surgery.
The prognosis for most babies born with brachial plexus injuries is good, but there is a potential for complications.
One possible complication is palsy. Depending on the severity of the injury, a child may experience weakness in the affected area, with partial or total paralysis and varying degrees of loss of sensation in the arm, wrist, or hand.
These complications are known as palsy and usually disappear as the nerves heal naturally or with treatment. In some cases, the dysfunction may be permanent. A child may also end up with chronically tightened muscles in the affected arm, also known as contractures.
The Prognosis for Mild Injuries
For mild brachial plexus injuries, the prognosis is overwhelmingly positive. An infant sustaining mild injuries to these nerves will likely experience a correspondingly mild form of brachial plexus palsy.
The infant may not move one arm as much as the other or have a weakened grip in that hand. However, these symptoms will generally disappear by three to six months of age.
For many of these mildly-affected infants, no treatment is needed for a positive outcome. Time is all it takes for the body to heal the injured nerves.
Others may need a little bit of physical therapy, such as range of motion exercises or massage, to help promote movement and sensation and to speed the process of natural healing.
The Prognosis for Moderate to Severe Injuries
The prognosis for moderate to severe brachial plexus injuries is not as good as for mild injuries but is still largely positive. A combination of surgery and follow-up physical therapy can significantly improve arm function.
The prognosis for such cases is much better than in the past, as surgical techniques for repairing nerves have improved.
Children who never fully recover from a brachial plexus injury may live with some degree of palsy for the rest of their lives. This is the weakness, paralysis, and loss of sensation caused by nerve damage.
Surgery and therapy can help alleviate the symptoms, but for severe injuries, no treatment can repair the nerve or completely eliminate the accompanying dysfunction.
A child with permanent disabilities may need ongoing physical and occupational therapy, assistive devices, and possibly corrective surgery but can otherwise live a long and healthy life.
If your child was born with a brachial plexus injury and has been given a poor prognosis, you may feel that someone is to blame for the lifelong disability.
Brachial plexus injuries during childbirth often result from doctor or hospital errors. If you consult with an experienced lawyer, you may be able to make a strong case for medical malpractice.
Compensation from a lawsuit can help your child continue to receive the treatment and assistive devices needed for healthy function.
- Brachial Plexus Injuries Information Page. (2019, March 27). National Institute of Neurological Disorders and Stroke | National Institute of Neurological Disorders and Stroke
Retrieved from: https://www.ninds.nih.gov/Disorders/All-Disorders/Brachial-Plexus-Injuries-Information-Page
- Treatment Options for Brachial Plexus Injuries. (2014, April 14). PubMed Central (PMC). National Institutes of Health.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045367/
- JE, M. (n.d.). Clinical decision making in brachial plexus injuries. - PubMed - NCBI. National Center for Biotechnology Information.
Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/1821729
- Rorabeck CH and Harris WR. (n.d.). Factors affecting the prognosis of brachial plexus injuries. - PubMed - NCBI. National Center for Biotechnology Information.
Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/7263755