Brachial Plexus Injury Treatment

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Infants born with brachial plexus damage have varying degrees of symptoms and disability. Brachial plexus injury treatment for mild cases, which fortunately includes most affected infants, is gentle physical therapy and time to heal. For those with more severe damage, different types of surgery can help repair damaged nerves and restore some function to the arm.[1]

What Is a Brachial Plexus Injury?

The brachial plexus is a bundle of five nerves that attach to the spinal cord and spread out to smaller nerves that control various parts of the arm (from the shoulder down to the fingers). During childbirth, overstretching may damage these nerves.

Pulling on the infant’s head as it comes through the birth canal, twisting the head and neck with respect to the shoulder, and even pressure in the birth canal can stretch the nerves of the brachial plexus.

Another possible cause of stretching is when a child is born breech, and their upraised arms as they emerge from the birth canal stretch the nerves. Risk factors for this damage include a large baby, breech birth, shoulder dystocia, and prolonged, difficult labor.

The injury to the nerves may be mild and cause damage simply by stretching them or could be more severe, including rips or complete tears away from the spinal cord. The symptoms of this kind of damage include paralysis, weakness, and loss of sensation in the arm.

The collection of symptoms caused by brachial plexus injury is called brachial plexus palsy. The specific nerves involved will lead to dysfunction in certain areas. Erb’s palsy refers to damage that causes symptoms in the upper part of the arm.

Lower arm symptoms are sometimes called Klumpke’s palsy. Damage caused by injury to all five brachial plexus nerves may be called global palsy, which may affect the function of the entire arm.

Non-Surgical Treatment

Some damage to the brachial plexus during childbirth isn’t rare, and in most instances, the injury is mild. A little overstretching, or even a moderate amount, is typically the type of injury that does not require much treatment. Most infants born with this will recover naturally as the nerves heal over three to six months.[2]

Infants with noticeable palsy caused by mild-to-moderate nerve damage benefit from physical therapy as the nerves heal.

Physical therapy can include a range of motion movements, strength and muscle-building exercises, gentle massage, and mobilization of joints.

Aquatic therapy can also be helpful for some children, as can neuromuscular electrical stimulation, which entails using a mild electrical current to stimulate muscle movement.

Nerve Graft

Most infants with brachial plexus injury will begin to recover within a few months, with a full recovery by six months.

If improvements are not seen or are not adequate by six months, surgery to correct nerve damage may be an option. Surgical treatment for these injuries is only necessary when nerves do not heal independently.[3]

If babies don’t improve within about six months, this could mean the damage was more severe and likely included tearing or some areas of complete separation from the spinal cord.

In the case of a nerve that is overstretched, not healing, or that has been torn, a surgeon may perform a nerve graft to repair damage and restore sensation and movement.

This involves using a donor’s nerve, typically from another part of the patient’s own body, and grafting it onto the damaged nerve to bypass the tear and promote healing.

Nerve Transfer

In even more severe cases, particularly when the nerve has torn away from the spinal cord, a nerve transfer may be needed. This also involves a donor nerve, which reconnects the torn nerve to the spinal cord.[3]

In some cases, a nerve transfer may be used instead of a nerve graft for a nerve that is damaged but not separated from the spinal cord. In this case, a transfer can be more targeted than a graft and may restore more sensation and movement to the affected muscle.

Other Surgical Treatments

Other types of surgeries may help children with brachial plexus injuries recover more movement or sensation. These may include muscle or tendon transfers.

This is most often done when surgery on the nerves is not possible because it has been delayed to the age of 12 months or older.

Severing and reconnecting muscles and tendons can restore some motion to affected arms and joints. Other surgeries that can help a child with brachial plexus injury include removing scar tissue from damaged nerves, shoulder and elbow reconstructions, and arthroscopic surgeries.

Botox Injections

Another treatment option for brachial plexus injuries is an injection of botulinum toxin A, also known as Botox. This toxin comes from a bacterium and causes paralysis.

Injections of botox can be localized to cause paralysis only where it is needed. There is a low risk that the toxin will spread to other parts of the body.

For brachial plexus injuries, Botox is used to help bring balance to the joints. When the shoulder or elbow is imbalanced, it is usually because one muscle, unaffected by the nerve damage, is stronger than another and is overpowering it.

Botox can temporarily paralyze or weaken that muscle so that the other one can become stronger with more use and will eventually balance out. Physical therapy to strengthen that muscle is typically utilized in conjunction with Botox injections.

Brachial plexus injuries are not always serious, but they can be. If you have a child born with this type of injury, you could be dealing with months of therapy and even surgeries. Your child could be facing lifelong complications. If you believe someone was at fault during childbirth, you may have a case to make for compensation.