Brachial Plexus Birth Injury | Diagnosis & Treatments

How is brachial plexus injury diagnosed?

Brachial plexus birth injury can be diagnosed by your baby’s pediatrician upon a thorough medical history and physical examination. Since the majority of babies with a brachial plexus injury recover in the first month to six weeks after they’re born, these exams can be scheduled with a primary care doctor. Children who continue to have problems beyond six weeks should be seen by a pediatric orthopedist or brachial plexus specialist.

In addition to a physical exam, doctors may conduct special imaging studies like an MRI or nerve conduction studies — although for babies, these tests are not as reliable as they are for adults. If doctors suspect that your child also has a fracture, they may take an x-ray, too. It’s important to find an experienced doctor who will be able to track your child’s progress over repeated exams.

Answers for parents whose baby is born with brachial plexus injury

How common is brachial plexus birth injury, what are the treatment options, and when is the best time to seek treatment from a specialist?

Boy with brachial plexus injury, with teddy bear and in diapers

How is brachial plexus injury treated?

Observation

Most brachial plexus injuries 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 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.

What are the surgical options for brachial plexus injury?

Children who continue to have problems 3 to 6 months after birth may benefit from surgical treatment. Your child's doctors have several surgical options for treating brachial plexus birth palsy, including:

Nerve surgery

Nerve surgery, also known as microsurgery, repairs or reconstructs the injured nerves and is recommended if recovery is still inadequate 3 to 6 months after birth. This surgery generally consists of a combination of nerve grafting and nerve transfer procedures. It is best performed between 3 and 9 months of life and is usually not beneficial for children beyond 1 year of age.

Nerve grafting surgery involves removing the injured portion of the nerve and replacing it with nerve grafts. These nerves usually come from the leg (sural nerves).

During nerve graft surgery, the injured portion of the brachial plexus nerve is removed and replaces with a section of sural nerve from the leg.

Nerve transfer surgery redirects nearby nerves from the arm or chest to take over for the damaged nerves.

During nerve transfer surgery, the damaged nerve is cut and a healthy nerve fiber is transferred into its place. Over time, the area of muscle weakness regains function.

Osteotomy

An osteotomy is a procedure in which bones are cut and reoriented to improve upper extremity function by better positioning the hand and arm. It is most commonly performed on the humerus (upper arm bone) or forearm.

Tendon transfers

A tendon is the end of a muscle that attaches to the bone.

Tendon transfers involve separating the tendon from its normal attachment and reattaching it to a new location. This procedure, typically performed between age 1 and adulthood, allows a healthy muscle to help a weaker or injured muscle to return to its desired function. Tendon transfers are usually done around the shoulder to improve the ability to raise the arm, but may be done in the forearm, wrist, or hand. Children are often in a cast for four to six weeks after surgery.

For tendon transfer surgery, the tendon of the weak or injured muscle is separated from its normal attachment point and reattached in a new location to restore arm function.

Open reduction of the shoulder joint (capsulorraphy)

Open reduction of the shoulder joint, performed through a surgical incision or using arthroscopy, reduces (placing the humeral head back in joint) and surgically tightens loose tissue around the shoulder joint. The procedure is needed when persistent muscle weakness has caused shoulder joint instability or dislocation. It is often performed in conjunction with other surgical procedures.

Free muscle transfers

A free muscle transfer is an extensive surgery, typically using leg muscles, which required reconnection of blood vessels and nerves under microscope. It is performed only when there are no local muscles in the arm or hand to replace dysfunctional muscles.

What is the long-term outlook for brachial plexus birth injury?

This depends on the extend of the injury and varies from patient to patient. Most children develop normal, or near normal, arm function without surgery. But not all children recover fully. For these children, surgery can improve strength and motion and support healthy development of their shoulder joint.