brachial plexus program
The brachial plexus (BRAY-key-el PLEK-sis) is a group of nerves that starts in the spinal cord at the neck and controls the hand, wrist, elbow and shoulder. The nerves signal these parts of the body to move and to feel (Picture 1).
In most cases an injury happens to the baby during birth. It can happen for several reasons.
The main cause is the birth of a large baby through a small birth passage (Picture 2). It can also happen if the mother has high blood sugar. Mothers with high blood sugar levels are more likely to have big babies.
If labor lasts longer than 24 hours, the doctor might have to use forceps, a suction device or other tools or surgeries to help the birth. Also, if the baby has trouble breathing or is in a hard birth position, the doctor may have to use tools to help the birth. The use of these tools may play a part in the injury.
A brachial plexus injury can happen if the baby’s shoulder is stretched during birth (shoulder dystocia—dis-TO-se-ah) or if he has a fracture, twisted neck muscles or shoulder dislocation.
An injury to the brachial plexus causes problems with the messages the nerves send to the shoulder, arm or hand on that side of the body.
Car accidents, sports injuries or falls may cause brachial plexus injuries in an older child.
Your child may have all or only some of the following symptoms on the side of the injury:
There are several levels of nerve damage.
These activities will encourage him to turn his head which prevents tight neck muscles or head flattening.
We closely watch your child’s injury through his first nine months of life. If he has a nerve avulsion (see above), he will need surgery in the first few months. After surgery, your child will be better able to move his arm and have increased feeling in his arm and hand. Sometimes other treatments are needed to help your child get and keep full use of his arm. Those may include splints, casts or Botox injections.
If he has one of the milder forms of nerve damage, you will be taught a series of exercises to do with your baby at home. The exercises help him learn to move his arm. He will be seen at ages three, six and nine months to see if he gets better without surgery. At each visit, we will see how your child is doing. We will watch for specific improvements in your child’s arm movement at each appointment. If the use of his arm does not get better with the exercises, your child will need surgery. It will be done between the ages of six and nine months. (see ROM exercises, HH-II-186)
Infants may also have mild symptoms which get better in the first month of life. They do not require surgery and completely recover in the first two years of life.
Your child’s treatment plan includes home exercises and regular follow up with the doctor. This is crucial for your child’s full recovery.
If there are any problems or if you have any questions, be sure to call the clinic at (614)-722-6692.
Brachial Plexus Injury (PDF)
HH I-334 3/11 Copyright 2011, Nationwide Children's Hospital