Brachial Plexus Injuries

Your arm, elbow and hand move because the nerves coming from your spinal cord and moving down into your shoulder send the signals from your brain. If something happens to this group of nerves, which is called the brachial plexus, you may have problems moving your arm, hand or wrist.

While brachial plexus injuries can result from injuries to the shoulder, the most common cause is a complication of birth. During childbirth, the baby’s shoulder can become stuck on the mother’s pubic bone (called shoulder dystocia). Doctors utilize  various techniques to help get the baby to continue through the birth canal, but the force needed to assist the delivery can cause stretching or tearing of the brachial plexus nerves.

The risk factors for this type of birth complication may include:

  • Babies weighing more than 8 pounds, 14 ounces
  • Gestational diabetes
  • Delivery past 40 weeks of gestation
  • History of shoulder dystocia during a previous delivery or of giving birth to large babies
  • Eight or more years between pregnancies
  • Protracted first or second stages of labor
  • Breech births

Mothers who are obese, very short or who have a contracted or flat pelvis may be more at risk.

What are the symptoms?

On occasion, a child may be born with some form of brachial plexus injury. Most will recover movement and feeling in the affected arm as the nerves heal. The injury can affect the upper, middle, lower nerves or a combination of the nerves.

Symptoms depend on which nerves are affected and the severity of the injury. The symptoms may include:

  • Weakness in one arm
  • Loss of feeling
  • Partial or total paralysis of the arm (not moving the arm)
  • Muscles contracting and pulling the arm inward
  • Decreased grip


If you notice your child having any of these symptoms, talk to your pediatrician. Your pediatrician will carefully examine your child and ask questions about his or her medical history including birth. Your child may need to have an X-ray or other imaging study on the bones and joints of the neck and shoulder. There are also tests that can be done to see if messages are getting through the nerves into the arm, shoulder and hand.

Medical Expertise at Palm Beach Children’s Hospital

Fortunately, Palm Beach Children’s Hospital has the expertise to diagnose and treat brachial plexus injuries. The primary treatment for brachial injuries is physical therapy. Parents will learn to do the range of motion exercises for infants and young children. These exercises help prevent joints from becoming stiff. Full recovery can take up to two years, so patience is needed.

If your child’s condition doesn’t change after six months of therapy, surgery may be recommended. Physicians at Palm Beach Children’s Hospital can perform surgeries that could include nerve surgery and tendon transfers. These surgeries are designed to repair or compensate for the damage. Our surgeons can also release muscles that are contracted. In some cases, nerves can be transplanted from another part of the body.

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