Brachial Birth Injuries: What You Need to Know

First published December 2016
Updated September 2026

It is very rare for newborns to be injured during childbirth. However, each year during the delivery process, about one out of 1,000 babies sustain injury to a network of nerves in their neck called the brachial plexus. The brachial plexus carries signals for feeling and movement from the spinal cord to the shoulder, arm and hand. When those nerves are damaged, the function of the entire arm can be seriously impacted.

The good news is that many of these injuries improve on their own and even injuries that are more serious can be successfully treated. The important thing is to identify injuries and start treatment as soon as possible to achieve the best outcome. Here are the most common questions the experts at our Brachial Plexus Program hear from parents.

How Does the Brachial Plexus Get Injured?

The injury is frequently caused when the baby’s shoulder gets stuck in the birth canal and stretched away from the head. This can cause the nerves to pull, tear or rip completely from the spinal cord. Brachial plexus injuries can also be caused by trauma, inflammation or as a result of a tumor.

What Are the Symptoms of a Brachial Plexus Injury?

The most common presentation is weakness or lack of movement in the affected shoulder, arm and hand. The arm may have a characteristic “waiter’s tip” appearance with the elbow straight and wrist flexed down. Some infants may have no movement in the arm at all, while others may just have mild differences from the other side.  

How Is a Brachial Plexus Injury Diagnosed?

If the child is a newborn, the specialized team will perform specific exams in clinic to assess how the baby is moving his/her arm. This is often done multiple times over a few months to determine what interventions are necessary. If a child has suffered trauma to the neck area, or is showing signs of an injury, physicians may use imaging technology such as magnetic resonance imaging (MRI), electromyography (EMG) or x-rays.

How Are Brachial Plexus Injuries Treated?

In many mild to moderate cases, physical therapy is used to help the child regain motion and flexibility. Some children might also have splints or Botox injections to help muscles loosen and improve movement. If the nerves have been severely stretched or torn, surgery may be the best option. Surgery to replace or reconnect damaged nerves is usually done within 6 months of the injury to give muscles the best chance at a full recovery – which can take up to three years.

If your pediatrician suspects your baby has an injury, they may refer you to a Brachial Plexus Program. This program includes experts from orthopedics, plastic surgery, physical medicine and rehabilitation, physical and occupational therapy, psychology, nursing and social work who will work with your family to provide comprehensive care for your child.