Even if you have planned every detail of your birth experience, the birth process is still very complicated and unpredictable. Sometimes during a difficult delivery, complications can occur. One complication that can happen is brachial plexus birth injury or brachial plexus injury (BPI).
While this injury can occur from other traumatic events in childhood and adulthood, between one and three of every 1,000 babies are born with BPI.
Rachel Bass, DO, a pediatric neurologist with Banner Children's, answers questions about BPI, treatment options and the best time to seek treatment from a health care specialist.
What is brachial plexus birth injury?
Brachial plexus birth injury is damage that can happen during labor and delivery to nerves known as the brachial plexus that run from the spinal cord in the neck to the arm and hand.
“The brachial plexus is a group of nerves responsible for controlling movement to different parts of the shoulders, arms, wrists and hands and carrying sensation (feeling) from those areas back to the brain,” Dr. Bass said. “When one, many or all of these nerves are damaged, it can cause muscle weakness including partial or full paralysis where you cannot move your shoulder, arm, wrist or fingers, with or without numbness.”
Infants may be born with some degree of BPI because the head, neck and shoulder were stretched as they came down the birth canal. Breech births, larger-than-average infants and long, difficult labor can increase BPI risk. However, over half of BPIs have no known risk factors.
How severe is brachial plexus birth injury?
The severity of BPI will depend on which nerves are damaged and the severity of the injury. For example, these nerves can be mildly stretched or, in serious cases, ripped apart or torn away from the spinal cord.
Brachial plexus birth injuries generally take one of two forms: Erb’s palsy or Klumpke’s paralysis/palsy.
“Erb’s palsy is a common type of injury that affects the upper brachial plexus nerves, causing issues with movement and sensation in the affected arm and shoulder,” Dr. Bass said. “Klumpke’s paralysis affects the lower brachial plexus nerves and can lead to issues with motion and sensation in the wrist and hand.”
If the upper and lower nerves are damaged, the condition can cause weakness in part of the shoulder as well as the entire arm, wrist, hand and fingers. This is called global or total brachial plexus birth palsy, which is uncommon compared to Erb’s palsy or Klumpke’s paralysis.
What are the symptoms of brachial plexus birth injury?
Symptoms are similar regardless of age, but a newborn cannot tell you they cannot move their arm or feel numbness or tingling. BPI can be painful in adults, but newborns aren’t in much pain because their nerves behave differently. This can make identifying BPI harder in newborns.
“Typically, this kind of injury is diagnosed shortly after childbirth when the newborn is evaluated by their health care provider,” Dr. Bass said.
The health care provider will look for signs that include:
- A weaker grip in one hand as compared to the other
- Movement in one arm but less in another
- An arm or shoulder that is rotated inward toward the body
Another sign of brachial plexus is when a baby doesn’t experience the Moro reflex (or startle response) on the affected side. Infants have a natural reflex from birth, which usually disappears by about six to nine months of age.
“The provider holds the baby’s head, neck and back and quickly brings their head down while holding them securely to see if the arms come out and upward equally,” Dr. Bass said.
If your child’s health care provider suspects BPI, they may order imaging to look for changes that could indicate an injury and/or order additional testing to evaluate the muscle and nerve function. These tests can help rule out other problems and determine the injury’s severity, which can help decide what treatments/interventions might be needed.
How is brachial plexus birth injury treated?
“Most cases of brachial plexus injury heal with just the help of physical therapy and/or occupational therapy, and many babies improve or recover within a few months to one year,” Dr. Bass said. “However, the nerves can take two to three years to heal completely, and nerves may not be able to fully recover function even when completely healed.”
Therapy may involve stretching, gentle massage and range of motion exercises.
Surgery may be considered to repair the damaged nerve or nerves in moderate to severe cases. The surgical procedures that are most often done to fix BPI are:
- Nerve graft: A nerve from another area of the body is used to repair the injured brachial nerve. These grafts help new nerves grow toward the muscles in the arm, shoulder and hand.
- Nerve transfer: A healthy nerve nearby is transferred to replace the damaged nerves.
- Muscle transfer: A muscle, usually taken from the baby’s thigh, replaces a paralyzed muscle in the arm.
- Tendon transfer: Tendons are moved from working muscles near the shoulder to increase arm movement and control.
- Osteotomy: A procedure where bones are cut and repositioned to improve movement.
What is the long-term outlook for brachial plexus birth injury?
The long-term outlook will depend on the extent of the injury and might vary from person to person. However, many newborns develop near-normal or normal function without surgery.
Newborns can develop BPI during childbirth. Newborns typically don’t experience much pain from this injury, but their arm function suffers. Early diagnosis and treatment offer the best chance for a newborn to recover fully.
Talk to their provider immediately if your newborn shows signs of brachial plexus damage.
Have questions or concerns about brachial plexus damage?
Schedule an appointment with a pediatrician near you.