Brachial Plexus Injuries

What are brachial plexus injuries?

A brachial plexus injury is an injury that occurs to the brachial plexus nerves. The brachial plexus nerves run between the neck and the shoulders. They control muscle function and feeling in the arms, shoulders, hands and chest. Brachial plexus injuries most often occur to a baby during a difficult birth. But they can also happen to older children from sports or car accidents.

There are four main types of brachial plexus injuries that happen during birth:

• Stretch (neurapraxia): This is the most common type and is the mildest form. In this injury, the nerve has been stretched and damaged, but not torn. The affected nerves generally recover by themselves, typically within a few weeks to months.
• Rupture: The nerve is torn, but not in a location where it is attached to the spinal cord. Surgery is usually needed for repair.
• Scar (neuroma): This occurs when scar tissue forms where the nerve has stretched or torn. It can put added pressure on the nerve.
• Avulsion: This is the most severe type of injury. The roots of the brachial plexus nerves are torn from the spinal cord. Babies usually need surgery for this type of injury.

There are also some specific conditions related to brachial plexus injuries:

• Horner syndrome: causes problems with the eyes and face
• Erb’s palsy: causes weakness in the shoulder and arm
• Global palsy: affects all five of the brachial plexus nerves

What are the signs and symptoms of brachial plexus injuries?

ommon symptoms of brachial plexus injuries may include:

• Muscle weakness in the arms or hands
• No movement in an arm or hand
• A shorter and smaller arm
• A limp arm
• Drooping eyelid

What causes brachial plexus injuries?

Brachial plexus injuries in newborns may be caused by:

• A long or difficult labor
• A larger-sized baby
• The baby being born in breech position (feet first)
• A delivery that requires vacuums or forceps
• A twin or multiple birth
• The baby’s head and neck pulling to one side during delivery

In some cases, there is no known cause of the injury.

Brachial plexus injuries in older children may be caused by sports injuries or car accidents.

How are brachial plexus injuries treated?

Your child's treatment for a brachial plexus injury will depend on the type and severity of the injury. Your care team at Arkansas Children's is experienced in treating brachial plexus injuries and will work with you to create the best treatment plan for your child.

Treatment options may include:

• Observation: Many mild injuries will heal on their own. The doctor will watch your child’s injury to make sure it is healing properly.
• Physical therapy: A therapist will teach you how to perform exercises with your child at home. This will prevent tightening of the muscles and joints and will encourage movement that is as normal as possible.
• Surgery: In some cases, your child may need surgery to repair or reconstruct the injured nerves. There are many types of surgery for brachial plexus injuries. The specific type of surgery your child needs will depend on their specific injury and symptoms.