Brachial plexus injuries are caused by damage to nerves that control movement and provide sensation in the arm. Adults and children can be injured in this way through some type of trauma, but the most common cases of damage to the brachial plexus is birth injury. A difficult birth, a breech birth, and other factors can cause the nerves to be stretched and damaged.
Injuries to the brachial plexus can cause symptoms that range from mild to severe and potentially, complications that are permanent. The prognosis for a brachial plexus injury strongly depends on the individual injury, its severity, the timeliness of treatment, and the effectiveness of the treatment. Some infants will recover completely and never experience symptoms again, while others may have lasting symptoms.
Brachial Plexus Injuries
The brachial plexus is the set of nerves that link the spinal cord to the small nerves that control the arms. Newborns may have brachial plexus injuries because of how they came out of the womb. Any type of difficulty of labor that causes the baby’s head, shoulder, or neck to be stretched or pulled can cause this damage. The stretching motion, if severe enough, can cause damage to the nerves that run through the neck and down the arm.
Damage to the brachial plexus may be mild and cause minimal symptoms, while in other cases it may be severe. This may include tears and rips, or an avulsion which is when a nerve or multiple nerves are torn completely away from the spinal cord. The damage may also vary depending on the nerve affected. Each of the five nerves control different parts of the arm, so symptoms may be experienced in the upper arm, lower arm, or the entire arm. Symptoms of a brachial plexus injury include loss of sensation, weakness, numbness, and partial or complete paralysis of muscles in the arm.
The Importance of Early Treatment
Mild cases of brachial plexus injury may not require any kind of treatment, or may benefit from some mild physical therapy. More severe injuries, on the other hand, may not heal if treatment is not administered. The most common type of treatment for injuries severe enough to cause tearing or avulsion is surgery to repair the damage. A donor nerve can be grafted onto a damaged portion of a brachial plexus nerve or used to reattach a nerve that separated from the spinal cord.
Recognizing the signs of brachial plexus injury and treating moderate to severe cases as soon as possible is important for giving a child the best chance of healing, of having minimal lasting symptoms, and of having the most positive brachial plexus prognosis. 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 is possible, before the damage and its consequences become irreversible. By the age of three or four months, an infant is ready to have surgery, if necessary. This gives doctors a chance to see if the baby will heal naturally and avoid the need for surgery.
The brachial plexus prognosis for most babies born with brachial plexus injuries is good, but there is a potential for complications. One of these is the development of palsy. Depending on the severity of the injury a child may experience weakness in the arm, partial or total paralysis in the arm, and varying degrees of loss of sensation. These complications may disappear as the nerves heal naturally or with treatment, but they may also be permanent. A child may also end up with permanent abnormal muscle contractions in the affected arm or tightened muscles.
Prognosis for Mild Injuries
For mild brachial plexus injuries the prognosis is overwhelmingly positive. An infant born with mild injuries to these nerves will likely experience some of the complications. The infant may not move one arm as much as the other or have weakened grip in that hand. However, these symptoms are likely to disappear by three or maybe six months of age.
For many of these affected infants, no treatment at all is needed to have such a positive outcome. Time is all it takes to heal the injured nerves. Others may need a little bit of physical therapy, such as range of motion exercises or massage to help improve movement and sensation and to speed the process of natural healing.
Prognosis for Moderate to Severe Injuries
The brachial plexus prognosis for more moderate or severe injuries is not as good as for mild injuries, but is still largely positive. A combination of surgery and follow up physical therapy can greatly improve the prognosis. The prognosis for such cases is much better than it was in the past as surgical techniques for repairing nerves has improved. Research has shown that nerve repair surgery can greatly improve the prognosis for an infant with brachial plexus injury as compared to the outlook that was given in the past.
Children who never fully recover from a brachial plexus may live with Erb’s palsy for the rest of their lives. This is the weakness, paralysis, and loss of sensation caused by the nerve damage. Surgeries and therapies can help alleviate the symptoms, but for severe injuries, no treatment is yet able to completely repair the nerve or completely eliminate symptoms. A child with these permanent impairments may need ongoing physical therapy, assistive devices, and occupational therapy, but otherwise can live a normal and long life.
If you have a child born with a brachial plexus injury and have been given a poor prognosis, you may feel as if someone is to blame for the lifelong disability. Brachial plexus injuries during childbirth are often ascribed to doctor or hospital error, and if you consult with an experienced lawyer you may be able to make a strong case. Compensation from a lawsuit can help your child continue to get the treatment and assistive devices he needs.