Brachial Plexus Birth Injuries

What are Brachial Plexus Birth Injuries

Brachial Plexus Birth Injuries are nerve injuries that can happen to a newborn during birth. The brachial plexus is a group of nerves that go from the spine to the shoulder, arm, hand, and fingers. These nerves allow movement and feeling in the shoulder, arm, hand, and fingers. Sometimes, other nerves near the brachial plexus can also be injured, such as the nerves to the diaphragm (phrenic nerves).

A baby with a brachial plexus injury may have damage to any part of these nerves. The nerve damage can range from mild to severe. Nerves can be stretched or torn. These injuries can cause the baby to have weakness, numbness, or loss of movement (paralysis). If the phrenic nerve is injured, this can affect the function of the diaphragm and cause difficulty with breathing. Minor injuries usually heal completely within 3 months.

What are the causes?

These injuries occur when the brachial plexus is stretched too far during birth. This can happen when the baby’s shoulders get stuck in the mother’s pelvis during labor (shoulder dystocia).

What increases the risk?

The following factors may make it more likely for these injuries to happen:

  • A long or difficult delivery.
  • A larger-than-average baby.
  • A bottom-first delivery (breech birth).
  • A delivery that requires force on the baby’s neck and shoulder.
  • Having had a previous delivery in which your baby got a brachial plexus injury.

What are the signs or symptoms?

Symptoms of this condition may cause your baby to have:

  • A limp or paralyzed arm.
  • Lack of muscle control in the arm, hand, or wrist.
  • Lack of feeling or sensation in the arm or hand.
  • Breathing problems.

Symptoms may be temporary or permanent, depending on the type of injury and how severe it is.

How is this diagnosed?

The injury may be diagnosed during a physical exam after birth. Your baby may also need tests, such as:

  • An X-ray. This ensures that there are no breaks in the neck, shoulder, or collarbone.
  • An electrical nerve and muscle test (nerve conduction study and electromyogram). This measures how well nerve signals travel through the nerves of the arms and shoulders. It helps to determine where the injury is and how severe it is.

How is this treated?

This condition may be treated with physical therapy to keep the baby’s muscles moving and to prevent stiffness. Physical therapy may include exercise and movement of the shoulder, arm, hand, and fingers. Other treatments may also be needed, such as:

  • Wearing a splint on the arm or hand.
  • Electrical stimulation.
  • Massage.
  • Surgery. This is usually done only after a period of waiting for the baby’s body to heal itself.

Follow these instructions at home:

  • Carefully follow all instructions from your baby’s health care provider. These may include instructions about how to keep your baby’s arm or hand positioned.
  • Do notpull on your baby’s arm.
  • Do notlift your baby up by the arms or under the arms. Pick your child up by the trunk (torso).
  • A physical therapist may teach you range-of-motion exercises for your baby’s arms. Make sure you understand how to do them. Do the exercises only as told by your baby’s physical therapist or health care provider.
  • Teach everyone who cares for your child the proper handling and exercise methods.
  • Keep all follow-up visits as told by your baby’s health care team. This is important.

Contact a health care provider if:

  • Your child’s condition does not improve in the expected time.
  • Your child’s symptoms get worse.

Get help right away if:

  • Your child has breathing problems. Look and listen for:
    • Rapid breathing.
    • Grunting sounds when breathing out.
    • Wheezing or whistling sounds when breathing out.
    • Sucking in of the space under or between the ribs when breathing in.

Summary

  • A brachial plexus injury is a nerve injury that can happen to a newborn during birth. The brachial plexus is a group of nerves that go from the spine to the shoulder, arm, hand, and fingers.
  • The brachial plexus can be injured during birth if there is a difficult or long delivery in which the baby’s shoulders get stuck in the mother’s pelvis (shoulder dystocia).
  • Treatment may involve physical therapy, a splint, electrical stimulation, or surgery.
  • Recovery will depend on the how severe the nerve injury is, but most injuries will heal on their own after several months.
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