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Brachial Plexus Injury (Pediatric)

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What is brachial plexus injury?

Brachial plexus injury involves the network of spinal nerves controlling movement of the arm and shoulder. Brachial plexus injury occurs when this network is stretched, compressed, or completely ripped away from the spinal cord.

What causes brachial plexus injury?

Brachial plexus injury is related to a difficult birth or to a later trauma of the area caused by contact sports, inflammation, tumor, or radiation therapy.

Who is affected by brachial plexus injury?

At risk are babies with increased birth weight, infants involved in multiple births, or those with shoulder dystocia, a shoulder that gets stuck in the birth canal during delivery.

There are several levels of brachial plexus injury ​sustained a birth. Most common is Erb-Duchenne palsy, an injury at the neck and top of the spine (cervical nerves 5-6). Also common is Klumpke palsy, an injury a little further down the spine (cervical nerve 8 to thoracic 1).

The degree of severity depends on the nature of injury. Brachial plexus injury​ ranges from temporary arm and shoulder weakness to complete paralysis of the arm.

How is brachial plexus injury diagnosed?

Our doctors begin with a thorough history. If brachial plexus injury is suspected in a newborn, we consider the child's birth weight, whether there were multiple births, if the shoulder was injured during delivery and the arm was limp at birth, and any changes in movement over time.

Our physical examination begins with an assessment of the arm, including size and bulk. We note the arm's temperature along with stretch reflexes, sensation, range of motion, and any associated problems such as fracture of the collarbone.

Electrodiagnostic testing may be ordered to further evaluate nerve and muscle response. X-ray and magnetic resonance imaging (MRI) studies also help to identify the causes of arm weakness.

What is the treatment for brachial plexus injury?

Our rehabilitation team begins treatment and family education as soon as the infant is diagnosed. We base treatment on the severity and types of injury and their duration.

Children with the mildest cases often recover spontaneously in 3 to 4 months. Others may benefit from:

  • Botulinum toxin injections (Botox) may be given to prevent joint contractures.
  • Custom-molded splints provide optimal position of the affected shoulder and arm down to the wrist and fingers.
  • Electrical stimulation and taping help to maintain or improve muscle strength and prevent muscle atrophy.
  • Physical therapy generally begins two weeks after diagnosis and includes positioning instructions and range of motion exercises.
  • Surgical intervention is considered for patients who show no improvement within 6 to 7 months of injury, suffer contractures or shoulder dislocation, display a lack of awareness of the hand or an altered body image, or show evidence of delayed motor coordination. Our physiatrist and therapists work with orthopedic surgeons to help children before and after surgery achieve the best outcome.

In addition, pain with trauma-related brachial plexus injury​ can be a significant problem. We help children to manage pain with oral medications, topical treatments, nerve surgery, or referral to a pain specialist.