What is a Brachial Plexus Injury?
An injury to the brachial plexus happens when the nerves are damaged. They may be stretched or compressed. They may even be ripped from the spinal cord. You may hear of minor injuries being referred to as burners or stingers. More severe injuries result in loss of movement or paralysis. The hand, arm or shoulder may be limited in function or feel numb with less sensation than normal.
This type of injury can occur in various scenarios. It can result from a car accident or from playing contact sports. When it happens with newborns, it occurs because of injury during birth. The baby’s head and neck may have gotten pulled to one side as they moved through the birth canal or the shoulders may have been stretched during delivery. If the baby was breeched, there may have been pressure on the arms that were raised.
Forms of Brachial Plexus Injury
The type of injury diagnosed depends on where the injury occurs. Klumpke paralysis is the name of the injury that affects the hand and lower arm. Klumpke paralysis is less common than brachial plexus palsy in newborns. Brachial plexus palsy, also known as Erb-Duchenne paralysis, is diagnosed when it affects the upper arm.
Brachial plexus may be misdiagnosed when a fracture occurs. The baby will have limited movement in either case, but the difference is whether bones or nerves are involved.
Certain factors increase the risk of brachial plexus injury. A breech delivery can lead to the injury or difficulty in getting the shoulders through the birth canal after the head has passed through. A baby that is larger than average can also cause delivery problems.
Symptoms and Treatment
Several signs may be evident if the baby has sustained injury during delivery which results in damage to the brachial plexus. They may not move their upper or lower arm or their hand on one side. They may not have much grip or they may hold the arm against the body in a straight position.
The doctor may perform a physical exam and notice that the baby cannot move the upper or lower arm. It may flop lifelessly when the newborn is rolled from one side to the other. The doctor may request an x-ray to rule out a fracture.
If the injury appears to be minor, the doctor may prescribe range of motion exercises and massage until the affected arm heals. In these cases, the baby is usually back to normal by a few weeks. For more serious injury, they may need to see a specialist and surgery may be required.
If the nerve has separated from the spinal cord, the damage may be permanent with limited use of the arm. Most infants will have a complete recovery by nine months. Otherwise, the prognosis isn’t good for future improvement.
