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Brachial Plexus Palsy

Nerves are small bundles of fibers that send and receive messages between the brain and the body. The brachial plexus is a set of these nerves that controls the shoulder, wrist, hand, and elbow muscles. It also provides feeling in the arm. It starts from the neck and extends down the arms.

The brachial plexus can become damaged, causing the nerves that usually send signals from the brain to the shoulders, wrists, hands, or elbows, to stop working. These muscles can then become weak, and can even cause a child to lose feeling or movement. When this happens, it’s called brachial plexus palsy.

Types

There are two main types of brachial plexus palsy:

  • Erb’s Palsy (also called Brachial Plexus Birth Palsy): This occurs when only the upper muscles—the shoulder and elbow—are affected.
  • Total Plexus Palsy (also called Global Plexus Palsy): This occurs when all of the muscles of the arm—shoulder, elbow, hand, and wrist—are affected.   

Symptoms

Children with brachial plexus palsy may experience several symptoms, including:

  • Weakness
  • Loss of feeling
  • Total or partial loss of movement
  • Pain

 

Another symptom can be the absence of the moro reflex: This is a healthy, involuntary response typically seen in newborns. Doctors check for this reflex after birth.

Usually, a baby’s head is lifted just enough to take its weight off a padded surface. As the doctor cradles the head, he allows it to drop briefly, just for a moment. The baby’s head never hits the padding, but normally, the baby will seem startled and move her arms to the side, arms up. Then she’ll pull her arms back toward her body.

An absence of the moro reflex can be a sign of brachial plexus palsy or another problem.

Causes

Brachial plexus palsy is usually a result of stretch injuries to a child’s head, neck, or shoulder. These injuries can happen during a difficult or complex birth (e.g., the shoulder gets stuck on the mother’s pelvis, causing it to stretch).

Not all brachial plexus palsies begin at birth. Older children may develop palsy after having an injury from an incident like a fall or fracture (break).

Diagnosis

Diagnosis begins with a physical exam. The physician will look for signs that show where the damage is located.

For example, narrowed eye pupils, drooping eyelids, or lack of ability for a child’s face to sweat could mean that the injury is near the spinal cord. If the child experiences pain when the doctor taps on certain nerves, this could suggest that the injury is farther away from the spinal cord.

The physician may also ordering imaging tests like X-rays or computed tomographic (CT) scans to get clear pictures of the injury.  

Treatment

Brachial plexus palsy tends to go away by itself, often within just a few months. If the physician thinks a child can heal on his own, he may recommend physical therapy to ease stiffness. Or, he may simply choose to monitor the injury.

Since palsy that doesn’t heal on its own can have lasting effects, the physician may eventually recommend surgery to repair or reconnect the damaged nerves.

Prevention

It’s not always possible to prevent brachial plexus palsy. However, avoiding a difficult birth can reduce the risk. An obstetrician can work with an expectant mother to keep the birthing process as smooth and easy as possible.

For example, larger-than-average newborns can be at an increased risk for getting a brachial plexus injury at birth. The obstetrician may recommend a Cesarean delivery (C-section) to lower that risk.

 

The OIC Brachial Plexus Team

At OIC we draw from a wide range of experts and expertise in order to help your child with his or her brachial plexus palsy. If you come to OIC for help, your team could include:

The Pediatric Orthopaedist specializes in the musculoskeletal system of children. They provide surgical interventions when necessary such as tendon lengthening.

The Pediatrician reviews medical issues and coordinates the general healthcare of the patient, in addition to working with the orthopaedic surgeon for pre-operative assessments if surgery is indicated and overseeing medical issues for hospitalized patients.

The Nurse Coordinator assists in making sure all medical orders are carried out, and provides case management and nursing assessment for the patient.

The Orthotist works with the team to prevent unequal or unbalanced muscle groups which can lead to deformities as the child grows.

The Cast Technician helps ensure that the casts and casting regimen your child requires is managed carefully and effectively to ensure that patients heal properly.