Obstetrical Brachial Plexus Palsy/Injury
Also known as: brachial plexus birth injury, obstetrical brachial plexus injury, birth-related brachial plexus injury, OBPI, BPBI, Erb’s palsy, global palsy
What is brachial plexus birth injury?
The brachial plexus is a network of nerves that run from the spinal cord, through the neck, to the arm. 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.
What causes brachial plexus birth injury?
During delivery of large babies, or smaller babies in breech presentation, the nerves of the brachial plexus may be stretched and injured. Some risk factors associated with brachial plexus birth injury include a long, difficult labor, a larger-than-normal infant, gestational diabetes, maternal obesity and breech presentation.
What are the symptoms of brachial plexus birth injury?
The symptoms can vary widely in severity based on the extent of the damage. There is incomplete sensory and motor function in the affected arm. The most common (and least severe) presentation is Erb’s palsy, in which the shoulder is internally rotated, the elbow extended, and the hand and wrist function normally.
The most severe presentation of brachial plexus birth injury, also known as global palsy, presents with complete paralysis of the affected arm, without function in the shoulder, elbow, forearm, wrist nor hand. There are intermediate presentations between Erb’s and global palsy.
What are brachial plexus birth injury care options?
Initial evaluation of patients with brachial plexus birth injury should take place within the first 1-2 months of life, and it should be performed at a center that specializes in the care of brachial plexus injuries. Despite the fact that many cases will recover spontaneously, early therapy with a pediatric occupational/physical therapist is critical to prevent permanent joint deformities from developing. If spontaneous recovery does not occur, surgery may be required to repair or reconstruct the damaged nerves.
In the most severe cases, this type of operation may be considered as early as 3 months of age. As the child grow, surgery may be considered to improve weak muscles and correct joint deformities; usually tendon transfers and bone repositioning.
Reviewed by: Aaron J. Berger
This page was last updated on: January 14, 2020 09:55 AM
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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.
Birth-related Brachial Plexus 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.
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.