Birth-related Brachial Plexus Injury
Also known as: brachial plexus palsy, brachial plexopathy, brachial plexus injury, obstetrical brachial plexus injury
What is birth-related brachial plexus palsy/injury?
Birth-related brachial plexus palsy refers to injury of the nerves that lead from the cervical (neck) spinal cord to the arm. These nerves can be injured during a difficult delivery. The result is weakness and/or loss of sensation in the affected arm.
What causes birth-related brachial plexus palsy/injury?
The cause of birth-related brachial plexus palsy is presumed to be stretch on the neck nerves during delivery. Multiple causes have been attributed to brachial plexus injury, but the two main risk factors are shoulder dystocia and macrosomia. Shoulder dystocia refers to the shoulder being stuck in the birth canal, and macrosomia refers to a high birth weight/larger than normal baby. Breech delivery is another possible contributor/risk factor for birth-related brachial plexus injury.
What are the symptoms of birth-related brachial plexus palsy/injury?
The main symptoms of birth-related brachial plexus injury include weakness and abnormal positioning of the affected arm and hand. The affected arm usually demonstrates a shoulder in adduction and internal rotation, an elbow in extension, and variable hand/wrist function.
What are birth-related brachial plexus palsy/injury care options?
The most important detail in the care of patients suffering from a brachial plexus injuries is that the patient is evaluated early (during the first month of life) by a specialist in brachial plexus surgery (usually a hand surgeon and/or microsurgeon). Ideally, the patient should be evaluated within the first month of life, and then monthly thereafter. In many cases, the nerves have been stretched but not torn, and, in these cases, the patient may recover function. However, in some cases, recovery of function may not occur or may be incomplete. Evaluation by the same team over a series of months is the most important tool in determining the severity of the injury and the treatment plan.
All patients with birth-related brachial plexus injury should be evaluated and treated by an occupational or physical therapist skilled in the treatment of these types of injuries. Care administered by the therapist includes specialized stretching and splinting of the affected arm. Recovery of muscle function in the affected arm requires close monitoring and special positioning of the joints to prevent permanent deformity in the growing bones and joints.
Imaging studies and nerve conduction studies may be needed to assist in determining the severity of the injury. In severe cases of birth-related brachial plexus injury, surgery may be needed to repair or reconstruct the damaged nerves.
Reviewed by: Aaron J Berger, MD
This page was last updated on: January 20, 2020 10:42 AM
Learn more about
Brachial Plexus and Peripheral Nerve Injuries
The brachial plexus is a network of peripheral nerves that originate in the neck region and branch off to various muscles of the arm to control movement and sensation in the shoulders, arm, forearm and hand. Injuries to the brachial plexus are most commonly seen in newborns during the process of child-birth. Other causes may include motor vehicle accidents or tumors that may affect the nerves.
Obstetrical Brachial Plexus Palsy/Injury
Brachial plexus birth injury refers to damage to the brachial plexus that occurs at birth, and may be related to a difficult labor and delivery.
Brachial Plexus and Peripheral Nerve Reconstruction
When peripheral nerves are unable to heal on their own, surgery is typically required to free them from scar, or it may be performed to repair or reconstruct them. Reconstruction of injured nerves can be performed with grafts from another part of the body, or transfers from a working muscle to a non-functioning muscle.