You spent a lot of time watching your newborn’s every movement. If one arm seems weaker or doesn't move like the other, it can be worrisome. In some cases, this may be a brachial plexus birth injury. These injuries can happen during delivery.
Most babies recover with time, therapy or surgery. At Banner Health, our pediatric specialists evaluate your child’s injury, monitor nerve recovery and growth and create a personalized treatment plan. Our goal is to help your child achieve a full range of motion.
What is a brachial plexus birth injury?
The brachial plexus is a group of nerves that are tightly packed together. These nerves start in your baby’s neck, go through the shoulder and down the arm. They control movement and feeling in the shoulder, arm and hand by sending signals from the spinal cord to the muscles.
A brachial plexus birth injury happens when these nerves get stretched, squeezed (compressed) or torn during birth. This can make it hard for your baby to move their arm. It might also affect how much they can feel in that arm.
What causes this injury?
Brachial plexus injuries can happen during difficult deliveries, especially when extra pressure is put on a baby’s shoulders.
Some things can increase the risk:
- Shoulder dystocia (when the baby’s shoulders get stuck behind the mother’s pelvic bone)
- A larger-than-average baby
- A long or difficult labor
- Breech delivery (when the baby comes out feet or bottom first)
- Using forceps or a vacuum extractor
It is important to know that this injury is not always preventable. These things can happen even in normal, careful deliveries.
Types of brachial plexus injuries
Brachial plexus birth injuries are usually classified by how severe the nerve damage is and which part of the nerve network is affected.
By severity (the nerve is damaged)
- Neuropraxia (stretch injury): This is the most common and mildest type. The nerve is stretched but not torn. Many babies recover fully within weeks or months.
- Neuroma: This happens when a hurt nerve tries to heal but scar tissue forms in the way. The scar blocks some of the signals from getting through. Your baby may get some movements back but not all of them.
- Rupture: A rupture means the nerve is torn but the tear is not at the spinal cord. Ruptures usually do not heal on their own. Surgery is often needed to fix the nerve using a graft from another part of the body.
- Avulsion: This is the most serious type. The nerve is torn away from the spinal cord. Avulsions cannot heal on their own and cannot be sewn back. Damaged tissue must be surgically replaced via nerve transfer (taking a healthy nerve from another spot to take over the job).
By location (which nerves are affected)
- Erb’s palsy (upper brachial plexus injury): Injury to the upper part of the brachial plexus is called Erb’s palsy. This is the most common form. A child typically has weakness in the shoulder and biceps muscles.
- Klumpke’s palsy (lower brachial plexus injury): Injury to only the lower part of the brachial plexus is called Klumpke’s palsy. This type affects the nerves that control the forearm and hand.
- Global or total plexus palsy (all nerves injured): If all the nerves are injured, it is called global or total plexus palsy. This is the most serious type. Children may have no movement in their shoulder, arm or hand.
Symptoms of brachial plexus birth injury
Most brachial plexus injuries are noticed within the first day or two after birth. Here are some signs you might notice:
- Your baby does not move one arm
- One arm hangs limp by the side
- The arm bends in an odd way
- Your baby has a weak grip on one hand
- The affected arm does not move during the startle reflex (Moro reflex)
- Your baby seems to prefer one arm over the other
- The muscles on one side feel soft or weak
Most newborns with brachial plexus don’t feel pain. But nerve damage might need further checkups and treatment. If your baby still can’t move their arm after a few weeks, call their health care provider. Early care makes a big difference.
How is a brachial plexus birth injury diagnosed?
If your child’s provider thinks your baby has a brachial plexus injury, they will start with a careful physical exam. They will watch how your baby moves. They will gently test each muscle. They will check reflexes and feeling in the arm.
In addition to a physical exam, your baby may also need some tests, such as:
- X-rays to check for broken bones in the shoulder or collarbone
- Ultrasound to look at the soft tissues
- MRI (magnetic resonance imaging) scan to see the nerves more clearly
- EMG (electromyography) to test how well the nerves send signals to the muscles
Treatment for brachial plexus birth injury
Most babies get better with time and treatment. About nine out of 10 babies heal without surgery.
Your baby’s care team may include the following specialists:
Nonsurgical treatment
- Watchful waiting: Many nerve injuries heal on their own within the first few months. Your care team will check your baby often to see how things are going.
- Physical therapy: A physical therapist will teach you gentle exercises to do with your baby at home. These exercises keep the joints loose and the muscles working. Starting therapy early is very important. Even just a few minutes each day can help.
- Occupational therapy: As your baby grows, an occupational therapist can help them learn to use their arm and hand for everyday tasks.
Surgery
If your baby is not improving by 3 to 9 months old, they may need surgery. Nerve surgery can repair, replace or rebuild damaged nerves. Older children may also need surgery on muscles or tendons to improve movement.
Procedures may include:
- Nerve surgery: This involves either nerve grafts to replace damaged nerves or nerve transfers.
- Muscle and tendon transfers: Muscles and tendons can be relocated to improve movement and control.
- Osteotomy: This involves surgically repositioning bones to improve the alignment of the hand and arm.
- Open reduction of the shoulder joint: This surgery stabilizes the shoulder by reducing dislocations and tightening the surrounding tissues.
Ongoing care
Some children need care for years as they grow, depending on the extent of the injury. Most children develop normal or near-normal arm function without surgery.
How you can help your baby at home
You can help your baby by:
- Doing daily exercises as instructed
- Encouraging your baby to use both arms during play
- Attending all follow-up visits
- Watching for changes in movement
When should you see a doctor?
Schedule an appointment with your baby’s health care provider if you notice any of these signs:
- Your baby still cannot move their arm after a few weeks
- The arm seems to be getting weaker, not stronger
- Your baby cries when you touch or move the arm
- The arm looks different from the other one
- Your baby is not meeting early movement goals
How Banner Health can help with brachial plexus birth injury
We know how scary a new diagnosis can be. You want the best for your baby and so do we. Our pediatric team has years of experience treating brachial plexus birth injuries. Here is what you can expect when you come to us:
- Experienced pediatric specialists
- Early evaluation and testing
- Personalized therapy plans
- Advanced surgery options
- Family-centered care
Make an appointment today with a Banner Health pediatric specialist or call 833-252-5535. The earlier your baby is seen, the more we can help them thrive.
Frequently asked questions
Can brachial plexus birth injuries heal on their own?
Most mild injuries get better over time but some need therapy or surgery. With proper care, most children go on to use their arm well.
Is brachial plexus birth injury the same as Erb’s palsy?
Erb’s palsy is one type of brachial plexus injury. It is the most common type. It affects the upper nerves of the brachial plexus.
Is a brachial plexus birth injury permanent?
Some cases fully recover while others may have lasting weakness or limitations.
Will my baby need surgery?
About one in 10 babies need surgery. If your baby is not improving by 3 to 9 months old, your provider may suggest it. Surgery today is safer and more effective than ever.
Can this injury happen again with future babies?
The risk is slightly higher in future births but many moms go on to have safe, healthy deliveries. Talk to your provider about your birth plan.
Will my baby be in pain?
Most babies are not in a lot of pain. The injury affects movement more than feeling. Some babies may be sore for a short time.
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