Brachial Plexus: What You Need to Know About This Childbirth Complication

It is very rare for newborns to be injured during childbirth. However, each year during the delivery process, about one out of 1,000 babies sustain injury to a network of nerves in their neck called the brachial plexus. The brachial plexus carries signals for feeling and movement from the spinal cord to the shoulder, arm and hand. When those nerves are damaged, the function of the entire arm can be seriously impacted.

The good news is that most of these injuries heal on their own and even injuries that are more serious can be successfully treated. The important thing is to identify injuries and start treatment as early as possible to achieve the best outcome. Here are the most common questions the experts at our Brachial Plexus Program hear from parents.

How does the brachial plexus get injured?

The injury is frequently caused when the baby’s shoulder gets stuck in the birth canal and stretched away from the head. This can cause the nerves to pull, tear or dislodge completely from the spinal cord. Brachial plexus injuries can also be caused by trauma, inflammation or as a result of a tumor.

What are the symptoms of a brachial plexus injury?

The most common presentation is weakness or lack of movement in the affected shoulder, arm and hand. The arm may have a characteristic “waiter’s tip” appearance with the arm straight and wrist bent back. Less common signs may be a droopy eyelid and small pupil on one side of the face, or breathing difficulties and poor feeding due to an impact on the diaphragm – a set of muscles involved in breathing.

How is a brachial plexus injury diagnosed?

If the child is a newborn, the healthcare team may just observe how the baby is moving his/her arm and hand to determine if more detailed tests are necessary. If a child has suffered trauma to the neck area, or is showing signs of an injury, physicians will use imaging technology such as magnetic resonance imaging (MRI), electromyography (EMG) or an x-ray.

How are brachial plexus injuries treated?

In many mild to moderate cases, physical therapy can be used to help the child regain motion and flexibility. Some children might also have splints or botox injections to help muscles loosen and improve movement. If the nerves have been severely stretched or torn, surgery may be the best option. Surgery to replace or reconnect damaged nerves is usually done within 6 months of the injury to give muscles the best chance at a full recovery – which can take up to three years.

I’m pregnant – how can I reduce the risk of my child having a brachial plexus injury?

There isn’t much that an expecting mom can do. Any situation that causes a prolonged labor or requires the use of forceps, such as a large birth weight, can increase the risk of a newborn developing a brachial plexus injury. These injuries are also more common in women who have gestational diabetes or who have previously had a vaginal delivery.

If your pediatrician suspects your baby has an injury, they may refer you to a Brachial Plexus Program. This program includes experts from orthopedics, plastic surgery, neurosurgery, physical and occupational therapy, nursing and social work who will work with your family to provide comprehensive care for your child.

Click here for more information on Nationwide Children’s Brachial Plexus Program or call 614) 722-6299 to request an appointment.

Kim Bjorklund, MD
Kim A. Bjorklund, MD, is a member of the Department of Plastic and Reconstructive Surgery, Hand Program and Center for Complex and Craniofacial Disorders at Nationwide Children's Hospital and is a Clinical Assistant Professor at The Ohio State University. Dr. Bjorklund also serves as the Director of the Brachial Plexus Program.Dr. Bjorklund received her medical degree and completed residency in Plastic Surgery at the University of Manitoba. Prior to joining Nationwide Children's, she completed Pediatric Plastic Surgery and Pediatric Hand and Upper Extremity fellowships at Cincinnati Children's Hospital, as well as a Hand and Microsurgery fellowship at Southern Illinois University School of Medicine. She is currently completing a Masters of Medical Education through the University of Cincinnati and the Surgical Education Research Fellowship through the Association of Surgical Education.Dr. Bjorklund specializes in pediatric hand and upper extremity surgery, with a focus on neonatal brachial plexus palsy, congenital limb differences and reconstruction following trauma or disease. Additional clinical and research interests are in pediatric microsurgery and surgical education.

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