Brachial plexus birth injuries

Summary

• The Brachial Plexus is a network of nerves that conducts signals from the spine to the shoulder, arm and hand.
• Damage to these nerves can lead to paralysis of the arm, a lack of muscle control or a lack of sensation in the arm and hand.
• There are three types of brachial plexus birth injuries: Avulsion, Rupture and Neuropraxia

Description

The Brachial Plexus is a network of nerves that conducts signals from the spine to the shoulder, arm and hand. Damage to these nerves can lead to paralysis of the arm, a lack of muscle control or a lack of sensation in the arm and hand.

Cause

Brachial plexus injuries are caused by damage to the Brachial Plexus nerves. There are three types of brachial plexus birth injuries:

• Avulsion, the most severe type, in which the nerve is torn from the spine
• Rupture, in which the nerve is torn but not at the spinal attachment, but further down in the shoulder
• Neuropraxia or stretch, in which the nerve has been damaged but not torn. Neuropraxia is the most common type of brachial plexus birth injury.

Symptoms

Symptoms may include a limp or paralysed arm, lack of muscle control in the arm, hand, or wrist, and lack of feeling or sensation in the arm or hand. Although injuries can occur at any time, many brachial plexus injuries happen during birth, when the baby's shoulders may become impacted during the birth process causing the brachial plexus nerves to stretch or tear.

Treatment

Some brachial plexus injuries may heal naturally. Many children improve or recover by three to four months of age. Treatment for brachial plexus injuries includes physiotherapy and in the case of avulsions and ruptures, surgery may be embarked on.

Prognosis

The site and type of brachial plexus injury determine the prognosis. For avulsion and rupture injuries there is no potential for recovery unless surgical reconnection is made in a timely manner. Most patients with neuropraxia injuries recover spontaneously with a 90-100% return of function.

Reviewed by Dr Andrew Rose-Innes, Yale University School of Medicine, 2007