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Brachial plexus birth palsies are often separated into different categories, depending upon the type of nerve injury and the pattern of nerves involved.
• The nerve roots are torn from the spinal cord – the injury occurs at the
• This is a less common form (roughly 10 to 20 percent of brachial plexus
• It cannot be surgically repaired directly – damaged tissue must be surgically replaced (nerve transfers).
• It can injure the nerve to the diaphragm, causing difficulty breathing.
• A droopy eyelid on the affected side may indicate a more severe injury (Horner's syndrome).
• The nerve is torn but not where it attaches to the spine – the injury occurs outside the spinal cord.
• It's a common form.
• It may require surgical repair.
• The nerve has been stretched but not torn – the
injury occurs inside the spinal cord.
• It's the most common form
• Affected nerve(s) may recover on their own – usually
within three months of the baby's life.
• The nerve has tried to heal, but scar tissue has
formed and presses against the injured nerve or
interferes with nerve function.
• It may require surgical treatment with nerve
reconstruction and/or secondary tendon transfers.
Terms used to describe different patterns of injury:
• This represents roughly 60 to 70 percent of brachial plexus birth palsy injuries.
• It involves the upper portion (C5, C6, and sometimes C7) of the brachial plexus.
• A child typically has weakness involving the muscles of the shoulder and biceps.
• Home physical therapy begins when a baby is 3-weeks old to prevent stiffness, atrophy and shoulder dislocation.
• This represents roughly 20 to 30 percent of brachial plexus birth palsy injuries.
• This represents roughly 20 to 30 percent of injuries.
• It is usually associated with an avulsion (a tear of the spinal cord).
• The sympathetic chain of nerves has been injured, usually in the T2 to T4 region.
• The child may have ptosis (drooping eyelid) miosis (smaller pupil of the eye), and anhydrosis (diminished
sweat production in part of the face.
• The child may have amore severe injury of the brachial plexus.
• This almost never occurs in babies or children.
• It involves the lower roots (C8, T1) of the brachial plexus.
• It typically affects the muscles of the hand.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”