Brachial Plexus Program | Types of Brachial Plexus Birth Palsy

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A close-up view of the nerves that make up the brachial plexus

Click to enlarge image

What are the four types of nerve injuries?

Brachial plexus birth palsies are often separated into different categories, depending upon the type of nerve injury and the pattern of nerves involved.

Avulsion

•   The nerve roots are torn from the spinal cord – the injury occurs at the
     spinal cord.
•   This is a less common form (roughly 10 to 20 percent of brachial plexus
    cases).
•   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.

Neurapraxia (stretch)

•   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.

Neuroma

•   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:

C5-C6-C7 (formerly called Erb's palsy)

•  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.

C5-T1 (total plexus involvement)

•  This represents roughly 20 to 30 percent of brachial plexus birth palsy injuries.

Horner's syndrome

•   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.

Klumpke's palsy

•   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.

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