Frequently Asked Questions - Brachial Plexus

Q: What causes a brachial plexus injury?

A: Brachial plexus injuries usually occur during a difficult delivery, such as with a large (macrosomic) baby, maternal diabetes, cephalopelvic diproportion, uterine hyperstimulation or a prolonged labor. It may also happen when the person assisting the delivery exerts excessive force pulling the baby from the birth canal. If one side of the baby's neck is stretched severely, the nerves may also be stretched, causing the injury.

The infant may not be able to move the arm, but may be able to move the fingers. If both the upper and lower nerves are stretched the injury is called a "global," or total, brachial plexus birth palsy.

Because of the loss of sensation from an epidural, a mother may not feel the pushing sensation, and the baby might descend in an awkward position. The use of tools, including forceps or vacuum may increase the risk of shoulder dystocia as well. Studies also suggest an association between an increased risk for shoulder dystocia and the use of labor-inducing drugs.

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Q: Brachial Plexus injuries: misconception and treatment?

A: Some babies recover on their own; however, some may require specialist intervention.

Pediatric neurosurgery is often required for avulsion repair. Lesions may heal over time and function return. Physiotherapeutic care is often required to regain muscle usage. Although range of motion is recovered in many children under one year in age, individuals who have not yet healed after this point will rarely gain full function in their arm and may develop arthritis.

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Q: What are the types of brachial plexus injuries?

A: There are categories of brachial plexus injuries defined by the nerves injured, extent of neuro damage. Erb's Palsy, Klumpke's and Horner's Syndrome are categories of these injuries. These conditions may cause the affected arm to become withered compared to the unaffected arm. This occurs because nerve innervation effects growth. It is the severity of the injury that affects both treatment decisions and the extent of recovery possible.