Birth-related Brachial Plexus Injury

Also known as: brachial plexus palsy, brachial plexopathy, brachial plexus injury, obstetrical brachial plexus injury, shoulder dystocia

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: 8/21/2018 2:15:46 PM

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