Brachial plexus injuries are often caused by trauma before or during delivery.
Brachial plexus injury is a term used to describe several conditions that disrupt or limit the network of nerves that carries neuroelectric signals to and from the spinal cord. Brachial plexus injuries are caused by trauma before or during delivery. There are a variety of symptoms that may range from being mild to severely limiting depending on the cause and location of the injury.
Brachial Plexus Injury
Brachial plexus injury occurs in 2 out of 1,000 live births. Difficult or lengthy labor, breech presentation, the use of forceps or vacuum, twin or multiple pregnancy, or a larger-than-usual baby can lead to brachial plexus injury and related conditions including Erb’s palsy. Brachial plexus injuries occur when the infant’s shoulder becomes lodged against the mother’s pubic bone, preventing the baby from passing through the birth canal. This condition is known as shoulder dystocia and requires interventions such as the use of forceps, use of a vacuum, or twisting the baby to free the shoulder.
These maneuvers may cause an injury to the brachial plexus nerves or cause Erb’s palsy. Safely delivering the baby is of critical importance under these circumstances; however, in some cases, physicians, nursing staff, or midwives may act without proper care and cause injury.
Symptoms of Brachial Plexus Injury
Brachial plexus injuries vary in severity and type and the symptoms range from mild to severe disability including total loss of sensation or motion of the hand or shoulder. Brachial plexus affects only one arm, but can happen to either arm. If the brachial plexus injury is minor, such as when the nerves are stretched or compressed, symptoms may not last a long time. Symptoms of brachial plexus injuries may include:
- Arm bent at the elbow and held against the body.
- Failure to move the lower or upper arm.
- Affected arm “flops” when newborn is rolled from side to side.
- Weaker grip on the affected side of the body.
- Absence of Moro reflex on the affected side.
Prognosis of Brachial Plexus
The outlook for babies suffering from brachial plexus depends on the severity of the condition. In case of obstetric brachial plexus, many of the minor symptoms go away on their own with time, and in some cases physical therapy may be required. However, if the brachial plexus injury has caused severe damage to the baby’s nerves, medication and surgery may be required. Mild brachial plexus injuries often heal within 3-6 months. If the infant does not recover within this period, the prognosis is generally poor.