Brachial Plexus Birth Palsy

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Contact the Brachial Plexus Program

  • 617-355-6021
  • International: +1-617-355-5209
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What is the brachial plexus?

The brachial plexus is a complex network of nerves between the neck and shoulders. These nerves control muscle function in the chest, shoulder, arms and hands, as well as sensibility (feeling) in the upper limbs.

What is brachial plexus birth palsy?

Brachial plexus birth palsy is an injury to the brachial plexus nerves that occurs in about one to three out of every 1,000 births

The nerves of the brachial plexus may be stretched, compressed, or torn in a difficult delivery. The result might be a loss of muscle function, or even paralysis of the upper arm.

Injuries may affect all or only a part of the brachial plexus:

  • Injuries to the upper brachial plexus (C5, C6) affect muscles of the shoulder and elbow.
  • Injuries to the lower brachial plexus (C7, C8 and T1) can affect muscles of the forearm and hand.

Brachial Plexus

What are the types of brachial plexus birth palsy?

Brachial plexus birth palsies are often categorized according to the type of nerve injury and the pattern of nerves involved. There are four types of nerve injuries.

Stretch (neurapraxia)

  • nerve has been stretched but not torn
  • injury occurs outside the spinal cord
  • most common form
  • usually affected nerve(s) may recover on their own usually within 3 months of the baby’s life

Rupture

  • nerve is torn, but not where it attaches to the spine
  • injury occurs outside the spinal cord
  • common form
  • may require surgical repair

Avulsion

  • nerve roots are torn from the spinal cord
  • injury occurs at the spinal cord
  • less common form (roughly 10 to 20 percent of cases
  • cannot be surgically repaired directly — damaged tissue must be surgically replaced (nerve transfers)
  • can injure the nerve to the diaphragm, causing difficulty with breathing
  • droopy eyelid on the affected side may indicate a more severe injury, such as Horner’s syndrome

Neuroma

  • nerve has tried to heal, but scar tissue has formed and presses against the injured nerve or interferes with nerve function
  • may require surgical treatment with nerve reconstruction and/or secondary tendon transfers

What are other forms of brachial plexus injuries?

Erb’s palsy

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

Total plexus involvement

This represents roughly 20 to 30 percent of brachial plexus injuries. All five nerves of the brachial plexus are involved (C5-T1). Children may not have any movement at the shoulder, arm or hand.

Horner’s syndrome

This represents roughly 10 to 20 percent of injuries. It is usually associated with an avulsion. 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 a more 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.

How we care for brachial plexus birth palsy

As a national and international referral center for children with brachial plexus birth palsy, the Brachial Plexus Program within the Orthopedic Center at Boston Children’s Hospital is among the largest in the world. The Program has treated hundreds to thousands of babies and children — as well as adolescents, young adults and even professional athletes who’ve sustained traumatic brachial plexus injury.

We’ve developed innovative non-surgical and surgical treatments for children with all degrees of severity of brachial plexus birth palsy. We can provide your child with expert diagnosis, treatment and care — as well as the benefits of some of the leading brachial plexus birth palsy clinical and scientific research.

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital
300 Longwood Avenue, Boston, MA 02115
For Patients: 617-355-6000
For Referring Providers: 844-BCH-PEDS | 844-224-7337

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