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There are many ways you can help children and their families get the care they need.
At Boston Children's Hospital, our Brachial Plexus Program team knows how concerned you are that your baby sustained an injury to her brachial plexus nerve network. We’ve developed innovative non-surgical and surgical treatments for children with all degrees of severity of brachial plexus birth palsy (BPBP). Learning more about this injury will help you feel more confident and in control as we treat—and work toward—healing your child.
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.
Brachial plexus birth palsy is an injury to the brachial plexus nerves that occurs during childbirth. 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:
During childbirth, stress can occur across a baby’s neck and head area, injuring the nerve(s). This stress usually happens when the head goes in one direction and the shoulder goes in another direction.
Yes, a traumatic brachial plexus injury can occur at any age—often as a result of a sports injury or car or work accident.
Brachial plexus birth palsies are often separated into different categories, depending upon the type of nerve injury and the pattern of nerves involved.
There are four different types of nerve injuries with different patterns that may occur:
Risk factors for sustaining brachial plexus birth palsy include:
Usually, the baby is not in much pain despite her BPBP, probably because infants’ nerves behave differently from adults’. Roughly, just 4 percent seem to experience severe pain. If a fracture accompanies the BPBP, the baby will experience some discomfort from the fracture, but not usually intense pain. And any fractures (clavicle, humerus) the baby may have will probably heal quickly—in about 10 days.
This is in contrast to an adult’s traumatic brachial plexus injury caused by accident or sports impact: In these cases, pain from BP injury is acute and disabling, as is pain from any accompanying fractures.
The prognosis is dependent on the extent of the injury, and for this reason, it varies from patient to patient:
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 6 weeks old. Less than half of children with BPBP 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.
Children’s pioneering research into the biology of brachial plexus birth palsy—and our experience in developing innovative treatments—means that your child will receive the most advanced care possible.
Boston Children’s Brachial Plexus Program is one of the world’s major centers for BPBP treatment. The program stands virtually alone in providing the entire spectrum of BPBP care—from early nerve surgery, to early therapy, to later reconstructive orthopedic surgery and therapy if this is needed. Our experts sub-specialize in BPBP, and we provide the entire spectrum of care all within one program. So, our team can follow your child closely throughout her treatment and recovery.
The main sign of brachial plexus birth palsy is that one of the newborn’s arms will lie at her side, sometimes in a “waiter’s tip” posture. The affected arm/hand does not move normally, in contrast to her other side.
Once your child’s pediatrician has made a diagnosis, it’s safe to wait up to four weeks for a comprehensive evaluation by an orthopedist and/or brachial plexus specialist.
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.”