Treatments for Brachial plexus birth palsy in Children

Boston Children's Hospital's Brachial Plexus Program provides comprehensive care—including evaluation, diagnosis, consultation, surgery, non-surgical therapies and follow-up care.

What are the non-surgical treatment options for brachial plexus birth palsy?


Most brachial plexus birth palsies will heal on their own. Your doctor will monitor your child closely. Many children improve or recover by 3 to 12 months of age. During this time, ongoing exams should be performed to monitor progress.

Physical therapy (and/or occupational therapy)

Therapy is recommended to help maximize use of the affected arm and prevent tightening of the muscles and joints.

With the teaching and guidance of therapists, parents learn how to perform range of motion (ROM) exercises at home with their child several times a day. These exercises are important to keep the joints and muscles moving as normally as possible.

Botox injections

•   help with joint motion
•   rebalance muscles
•   prevent contractures and shoulder dislocations

What are the surgical options for brachial plexus birth palsy?

Children who continue to have problems three to six months after birth may benefit from surgical treatment. Your child's doctors have several surgical options for treating brachial plexus birth palsy, including:

•   Microsurgery (10 to 20 percent of all BPBP surgery)
•   Tendon transfers
•   Open reduction of the shoulder joint (capsulorraphy)
•   Osteotomy
•   Free muscle transfers

Visit our Brachial Plexus Program to learn more about these surgical options.

What are the complications of brachial plexus birth palsy surgery?

Complications after surgery are uncommon but can occur, and can be either temporary or permanent. These include:

•   stiff joints—can be treated with physical therapy
•   pain from nerve damage (very unlikely)
•   muscle atrophy due to incomplete recovery
•   disability from incomplete recovery
•   the biggest worry is that the arm and hand will not get as close to normal as hoped

Generally, surgery does not make children worse, but does not always lead to full recovery.

Caring for your child after surgery

After your child's BPBP surgery, her Boston Children's pediatric orthopedist and physical therapist will advise you of physical therapy exercises you can do with your child at home. Her doctor can also help you plan a nutritional program and a personal exercise regimen to optimize your child's recovery.

Long-term outlook

The good news is that—either spontaneously or with therapy—most of our young patients recover fully or nearly fully by the time they're 6 to 12 months old. Some may even begin to recover when they're just 6 weeks old. Less than half of children with BPBP will need nerve surgery. Some require tendon transfers. The outcomes from these surgeries are favorable for improved long-term function.

If needed, your child's rehabilitation team will work with you and your child to learn home exercises that are important to her recovery. Most parents perform range of motion (ROM) exercises at home with their child many times a day for several years. These exercises are important for keeping the joints and muscles moving as normally as possible.

Coping and support

At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

•   getting to Boston Children's
•   accommodations
•   navigating the hospital experience
•   resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with BPBP. Will this affect my child long term? When can she return to her sports and activities? Children's can connect you with extensive resources to help you and your family through this stressful time, including:

   •   patient education: From doctor's appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child's treatment and help answer any questions you may have—Why will my child need surgery? Are there non-surgical options? How long will her recovery take? How should we manage home exercises and physical therapy? We'll help you coordinate and continue the care and support your child received while at Boston Children's.

   •   parent-to-parent: Want to talk with someone whose child has been treated for BPBP? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share their experiences.

   •   faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.

   •   social work: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.