Brachial Plexus Injuries

Helping Children Live Life With Ease

Living with brachial plexus injuries can make activities using the arm challenging or even impossible. We have a team of compassionate orthopedists specializing in pediatric brachial plexus injury treatment at Palm Beach Children's Hospital who want nothing but to see children happy.

Medical Expertise at Palm Beach Children’s Hospital

At Palm Beach Children’s Hospital in West Palm Beach, Florida, we have the expertise to diagnose and treat brachial plexus injuries. If brachial plexus injury symptoms are suspected, our doctors may conduct physical and diagnostic imaging examinations to evaluate a patient's brachial plexus condition further.

The primary treatment for brachial injuries is physical therapy. As a parent, you will learn to do range-of-motion exercises for your infant or young child. These exercises can prevent joints from becoming stiff. Full recovery can take up to two years, so be patient. Surgery may be recommended if your child’s condition does not improve after six months of therapy. Our physicians can perform various treatments to restore arm function.

What Is a Brachial Plexus Injury?

The brachial plexus is a network of nerves on each side of the body that gives feeling and movement to the hand, arm and shoulder. The nerves making up the brachial plexus come from the spinal cord and pass between the bones of the neck and into the arm. These nerves merge near the shoulder, along the side of the neck. From here, they branch out to form a plexus or “highway system” of nerves.

You can move your arm, elbow and hand because the brachial plexus coming from your spinal cord and pushing down into your shoulder sends signals from your brain. Brachial plexus injuries happen when nerves are damaged, resulting in problems moving your arm, hand or wrist. 

Since the brachial plexus has five nerves, each serving its specific function, knowing the location of the nerve injury can help a doctor plan the treatment. Here are the four types of nerve injuries:

• Avulsion: the most severe type, avulsion happens when the nerve’s root is completely disconnected from the spinal cord.
• Neurapraxia: the least severe type, neurapraxia, occurs when the nerves are stretched.
• Rupture: occurs when a part of the nerve is torn.
• Neuroma: when scar tissue forms on the stretched nerve as it self-repairs.

Here are the types of brachial plexus injuries:

• Brachial neuritis: also known as Parsonage-Turner syndrome, this rare condition happens without any apparent shoulder injury. It is marked by an episode of sudden, excruciating shoulder pain followed by intense weakness.
• Erb’s palsy: the upper brachial plexus nerves are damaged.
• Klumpke palsy: the lower nerves of the brachial plexus are injured.

What Are the Symptoms of Brachial Plexus Injury?

Brachial plexus injury symptoms depend on which nerves are affected and the severity of the injury and may include:

• Weakness in the affected arm
• Loss of feeling or sensation in the hand or arm
• Partial or total paralysis of the arm, causing it to hang limply
• Muscles contracting and pulling the arm inward
• Decreased grip

If you notice your child having any of these symptoms, talk to your pediatrician, who will carefully examine your child and ask you questions about their birth and medical history. Your child may need to have an X-ray or other imaging tests on the bones and joints in the neck and shoulder to check the extent of injury and nerve activity in the arm, shoulder and hand.

The process of receiving a diagnosis may include:

• MRI, CT scan or other imaging tests
• X-ray of the shoulder and neck area
• Electrodiagnostic studies to locate nerve injury, evaluate its severity and assess its recovery rate

For infants, some brachial plexus injury symptoms can be seen right after birth. These symptoms may include:

• No movement in the upper limb
• Absence of Moro reflex or involuntary reaction to stimulation
• The affected limb is straight at the elbow and held against the body

Physical exams often show that the baby cannot move the affected arm or hand. The healthcare provider may need an X-ray to examine the infant’s collarbone for any fracture.

How Does a Brachial Plexus Injury Occur?

During a difficult delivery, a baby’s brachial plexus can get injured in the following ways:

• When the baby’s neck and head stretch to the side as the shoulders pass through the birth canal
• When the baby’s shoulders get stretched during a head-first childbirth
• When there is pressure on the infant’s raised arms during a breech or feet-first delivery

Doctors may have to use various techniques to help get the baby through the birth canal, but the force needed to assist the delivery can cause stretching or tearing of the infant’s brachial plexus nerves. The following are some risk factors that can contribute to a child getting brachial plexus injury during birth:

• Shoulder dystocia or when the baby’s shoulder becomes stuck in the mother’s pelvis after the head has already come out
• History of shoulder dystocia during a previous delivery or of giving birth to large babies 
• Babies weighing more than 8 pounds, 14 ounces
• Delivery past 40 weeks (about 9 months) of gestation
• Mothers who are obese, very short or have a contracted or flat pelvis
• Eight or more years gap between pregnancies
• Protracted first or second stages of labor
• Gestational diabetes
• Breech births

Other causes of brachial plexus injury include falls, vehicle accidents, athletic injuries and gunshot wounds. Radiation therapy, autoimmune disorders and cancer can also damage the brachial plexus.

How Do You Treat a Brachial Plexus Injury?

We understand that surgery can be a scary experience for some children. The good news is our orthopedic surgeons in West Palm Beach, Florida provide care and treatment options that will make your child feel safe, acknowledged and supported.

If our doctors determine that your child’s injury may heal without surgery, we may monitor the damage and delay invasive procedures. Your child may undergo physical therapy to prevent muscle and joint stiffness.

Most infants will fully heal within 3 to 4 months. Mild brachial plexus injury treatment may include gentle massage of the arm and range-of-motion exercises. If the baby’s condition does not improve in the first few weeks, a specialist may need to reevaluate them. Surgery may be recommended if they reach 3 to 9 months without any improvements.

Brachial plexus injury surgery may be performed when nerves fail to heal independently or enough to recover the necessary arm and hand function. However, surgery may or may not return the affected limb’s function to normal, depending on the severity of the injury.

Nerve Repair
In brachial plexus injury repair treatment, the surgeon will attach the two torn edges of a damaged nerve. Typically, this treatment is recommended for lacerations that rupture the nerves.

Nerve Graft
This procedure involves taking a healthy nerve from another part of the body to bridge the two ends of the split nerves. The transplanted nerve will support the damaged ends as they grow back together. However, nerve grafting can only work if the nerve stump at the spinal cord still functions.

Nerve Transfer
A nerve transfer may be performed when a nerve completely loses muscle sensation or function. A surgeon will reconnect a healthy donor nerve to the damaged nerve. Then the healthy nerve will provide a nerve signal to a paralyzed muscle to restore the muscle’s function.

Tendon and Muscle Transfers
These procedures are recommended for some patients who have poor outcomes with nerve repair or reconstruction procedures.