Michigan and Co-Counsel Nationwide
Brachial Plexus Injuries
The brachial plexus is a bundle of nerves originating in the brain, travel through the spinal cord and exit the spinal cord in the neck. These nerves then travel through the neck and into the shoulder providing the sensory and motor/muscle control of the arms. When a brachial plexus injury occurs, it is from stretching or tearing of these nerves. The injury can result in loss of sensory and motor/muscle function in the arm.
A brachial plexus injury occurs in approximately 1-2 infants for every 1000 children born. The nerves can be damaged when the baby’s neck is stretched too far during the delivery process. The stretching can be caused from a variety of conditions due to the mother or the infant. Risk factors for a brachial plexus injury are listed below. Luckily, the vast majority of these injuries heal themselves in the first 6 months of life.
Maternal risk factors for brachial plexus injuries include diabetes, obesity, a prolonged second stage of labor, forceps or vacuum delivery, small pelvis.
Infant risk factors include large head, overdue (>40 weeks of gestation), shoulder dystocia.
Shoulder dystocia occurs when the baby’s head is delivered but the shoulders get stuck in the birth canal. The baby’s shoulders become lodged in the mother’s pelvis and must be manipulated by the birthing attendant/physician in order for the child to be born. The vast majority of cases of shoulder dystocia do not result in any injury to the child.
Brachial plexus injuries are found shortly after birth, within the first day or two of life. The infant will hold its arm in a characteristic pattern and the arm will not be moved. The infant will lay in the nursery with its arm limp at the side of the body. When one moves the arm, it will flop back down and hang loose at the infant’s side.
Associated injuries that can occur when the brachial plexus has been injured are clavicle and humerus fractures, torticollis or twisting of the neck, bruising, facial nerve palsy or a lack of facial expression on one side of the face and the infant may experience breathing difficulty.
Treatment for brachial plexus injuries is limited to watchful waiting to see if the injury will heal itself. If the arm is weak and the child is favoring the other arm, physical and occupational therapy are undertaken. Finally, surgery as a last resort may be required to repair the nerve damage. When the nerves do not heal, the child can be left with permanent disability in the arm; decreased muscle control and sensation.
ACOG, the American Congress of Obstetricians and Gynecologists, has recommendations in place to help prevent birth injuries like brachial plexus and Erb’s palsy. ACOG recommends that a cesarean section be performed if the estimated fetal weight is greater than 4.5 kg or 10 pounds.