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Brachial plexus injury is a loss of movement or weakness of the arm that occurs when the collection of nerves around the shoulder are damaged during birth.
This bundle of nerves is called the brachial plexus.
Alternative NamesKlumpke paralysis; Erb-Duchenne paralysis; Erb's palsy; Brachial palsy
Causes, incidence, and risk factorsThe nerves of the brachial plexus can be injured during a difficult delivery from:
- The infant's head and neck pulling toward the side as the shoulders pass through the birth canal
- Pulling on the infant's shoulders during a head-first delivery
- Pressure on the baby's raised arms during a breech (feet-first) delivery
There are different forms of brachial plexus injury in an infant. The type depends on the amount of arm paralysis:
- Brachial plexus injuries usually affect only the upper arm.
- Erb's paralysis affects the upper and lower arm.
- Klumpke paralysis affects the hand. The infant may also have an eyelid droop on the opposite side.
The following increase the risk of brachial plexus injury:
- Breech delivery
- Larger-than-average newborn (such as an infant of a diabetic mother)
- Difficulty delivering the baby's shoulder after the head has already come out (called shoulder dystocia)
Brachial plexus injury is less common now that delivery techniques have improved. Cesarean delivery is used more often when there are concerns about a difficult delivery. Although a c-section reduces the risk of injury it does not prevent it, and this delivery also has other risks.
Brachial plexus injury may be confused with a condition called pseudoparalysis, in which the infant has a fracture and is not moving the arm because of pain, but there is no damage to the nerves.
SymptomsSymptoms can be seen immediately or soon after birth, and may include:
- Newborn is not moving the upper or lower arm or hand
- Absent Moro reflex on the affected side
- Arm flexed (bent) at elbow and held against body
- Decreased grip on the affected side
A physical exam usually shows that the infant is not moving the upper or lower arm or hand. The affected arm may flop when the infant is rolled from side to side.
The Moro reflexis absent on the side with the brachial plexus or nerve injury.
A careful examination of the clavicle or collarbone will be done to look for a fracture. Sometimes, the infant will need to have an x-ray of this bone.
TreatmentGentle massage of the arm and range-of-motion exercises are recommended for mild cases. More severe cases, or those that do not improve in the first few weeks of life may need to be evaluated by several specialists.
If some strength has not returned to the affected muscles by the time the baby is 3 - 6 months old, surgery may be considered.
Expectations (prognosis)Most babies will fully recover within 3 to 6 months, but those who do not recover have a poor outlook. In these cases there may be a separation of the nerve root from the spinal cord (avulsion).
It is not clear whether surgery to repair the nerves or fix the nerve problem can help. Nerve grafts and nerve transfers are sometimes tried.
In cases of pseudoparalysis, the child will begin to use the affected arm as the fracture heals. Fractures in infants usually heal very quickly and easily.
ComplicationsComplications include:
- Abnormal muscle contractions (contractures) or tightening of the muscles, which may be permanent
- Permanent, partial, or total loss of function of the affected nerves, causing paralysis of the arm or arm weakness
Call your health care provider if your newborn shows a lack of movement of either arm.
PreventionTaking measures to avoid a difficult delivery, whenever possible, reduces the risk of brachial plexus injury in newborn babies.
ReferencesFenichel GM. Trauma and vascular disorders. In: Fenichel GM, ed. Neonatal Neurology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2006:chap 5.
Pham CB, Kratz JR, Jelin Ac, Gelfand AA. Child neurology: brachial plexus birth injury: what every neurologist needs to know. Neurology. 2011. 77:695-697.
Reviewed ByReview Date: 11/14/2011
Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
What else can I help you with?
What is the differential diagnosis on pain in scapular region after an avulsion fracture of the upper humerus?
Brachial plexus injury Hyperabduction syndrome Result generated by DiagnosisPro at: http://en.diagnosispro.com/disease_information-for/brachial-plexus-stretch-injury/11419.html
What are some effective exercises for rehabilitation and strengthening of the brachial plexus following an injury?
Some effective exercises for rehabilitating and strengthening the brachial plexus after an injury include gentle stretching, range of motion exercises, nerve gliding exercises, and strengthening exercises targeting the muscles connected to the brachial plexus. It is important to work with a physical therapist to create a personalized exercise plan that is safe and effective for your specific injury.
The median nerve is a member of which nerve plexus?
The median nerve is a member of the brachial plexus. It is formed by contributions from the lateral and medial cords of the brachial plexus, primarily from spinal nerve roots C6, C7, C8, and T1.
What type of injury can occur if the patient's arms are hyperextended past a 90-degree angle on an arm board?
Brachial Plexus Injury
Which common injuries can cause a person to need brachial plexus surgery?
A brachial plexus injury is an injury to the network of nerves that send signals from one's spine to their shoulder, arm, and hand. In serious injuries, the nerves are torn. Common injuries include those sustained during contact sports, auto or motorcycle accidents, or falls. Babies can sustain brachial plexus injuries during birth.
What is erb's paralysis?
injury to the upper trunk of brachial plexus there are 8 nerve meet at erb's point
How would one know if they have a brachial plexus injury?
Brachial Plexus injuries are caused by damaging of nerves in the shoulder. They can be detected by a loss or decrease in feeling, as well as decreased muscle function in the hand or arm affected.
What is the plexus supplying the arm?
Brachial plexus (C5-T1)
Which cord of the brachial plexus gives the radial nerve?
The radial nerve is derived from the posterior cord of the brachial plexus, which is formed by the fusion of the posterior divisions of the upper, middle, and lower trunks of the brachial plexus.
What is the nerve plexus that supplies the muscles of the upper extremity?
The brachial plexus.
What does stinger mean in medical terms?
Stinger in medical terms refers an injury to the brachial plexus, usually during athletic participation.
What does the brachial plexus do?
The function of the brachial plexus is cutaneous and muscular innervation of the upper limb. It is a network of nerves running from the spine and neck into the arm.
