What is Brachial Plexus

Although the overwhelming majority of vaginal births are successful and result in a healthy baby, that is not always the case. One of the difficulties that can sometimes happen with so-called natural births is injury to the brachial plexus. Understanding the nature of this condition can help you to determine whether the personnel involved in your baby’s birth should be held legally liable.

What is the Brachial Plexus?

Each side of your body contains a brachial plexus. This is a collection of five separate nerves that run from your neck where it meets the spinal cord, across your chest and down into your armpit. These two sets of nerves control sensation and movement in your shoulders, arms and hands. When an injury to the brachial plexus occurs, it generally only affects one side of the body.

What is a Brachial Plexus Injury?

When any of the five nerves in this grouping on either side of the body is traumatically pulled, stretched, compressed or torn, you can potentially experience weakness, loss of sensation and impaired ability to move your shoulder, arm or hand. Each year, thousands of babies sustain injuries to the brachial plexus that can significantly affect their lives.

How Severe Are Brachial Plexus Injuries?

Depending on how the injury occurred, patients may experience the brachial plexus injury to a lesser or greater degree. Severity levels include the following:

• Rupture. This occurs when a nerve is excessively stretched but not at the spinal cord attachment. If a nerve is torn or ruptured in this way, surgery may be required to repair it.
• Neuropraxia. Also resulting from stretching, this type of injury occurs at the point where the nerve attaches to the spinal cord. With treatment, function can usually be restored.
• Evulsion. In this most serious of medical events to the brachial plexus, the nerve root is completely torn and separated from the spinal cord. Even with surgery, evulsion injuries are often permanent and cannot be repaired.

What Are The Most Common Types of Brachial Plexus Injuries in Infants?

Babies are particularly susceptible to the following types of brachial plexus injuries:

• Neuropraxia. This is the most minor of the injury types and involves relatively minimal tears or strains in the protective lining and covering of the nerve, usually without affecting the nerve itself. Neuropraxia usually heals on its own over the course of a few months. Symptoms in the affected arm include muscle weakness, burning, tingling, numbness, extreme sensation and sensation disturbances.
• Erb’s Palsy. Also known as brachial plexus birth palsy, this condition happens when nerves in the upper arm are damaged. The severity of this palsy varies according to how the injury occurred and the extent of the damage. Symptoms in the affected arm include loss of motor or sensory functioning, full or partial paralysis, numbness or decreased ability to grip and limpness or hanging of the affected limb. Forms of treatment include medications, surgery, physical and massage therapy.
• Klumpke’s Palsy. This occurs when the lower brachial plexus nerve roots (C8-T1) are damaged. Impacting the arm, wrist and hand of the affected side of the body, this palsy occurs when the baby becomes lodged against the mother’s pelvic bone during delivery. As a consequence, the infant’s arms can become severely stretched, leading to shoulder dystocia. In some milder cases, Klumpke’s Palsy heals on its own; however, partial or full paralysis will require medication, surgery or both.

What Are the Primary Causes of Brachial Plexus Injuries?

There are several common causes of this condition in babies:

• Improper use of medical tools during delivery. If the baby becomes stuck in the birth canal or has a hard time moving, doctors may use tools such as forceps or vacuum extraction devices. If any of this equipment is used improperly or with too much force, all types and severities of brachial plexus injury can result.
• Excessive pulling during delivery. This can happen even when medical devices are not employed.
• Breech births. When a baby is born with its feet or buttocks emerging first, brachial plexus injuries are more common.
• Shoulder dystocia. This condition occurs when one or both of the baby’s shoulders gets stuck behind the mother’s pelvic bone. Instances of shoulder dystocia often happen when doctors proceed with a vaginal delivery even after a c-section is the more advisable course.
• Prolonged contractions, especially during the time when the baby is proceeding through the mother’s pelvic area. Injuries frequently occur when doctors attempt to use force to move the labor along.

What Are the Risk Factors for Brachial Plexus Injuries?

Several factors put a baby at greater risk for a brachial plexus injury:

• Abnormal Fetal presentation.
• Macrosomia (fetus is much larger than average).
• Gestational diabetes.
• Maternal obesity.

In many situations, c-sections are recommended for mothers and babies at high risk.

What Are the Symptoms of Brachial Plexus Injury in Newborns?

Although signs of a minor injury usually resolve on their own, parents should remain vigilant and notify medical professionals if they are concerned. Signs include lack of movement, weak grip, pain and awkward positioning of the arm or hand.

On the other hand, symptoms of a severe injury are more noticeable. They include intense pain, muscle weakness, numbness in the affected area, total or partial paralysis in the shoulder or upper arm, Erb’s or Klumpke’s Palsy or Horner’s syndrome (caused by traumatic damage to the sympathetic nerves serving the eyes).

What Are the Consequences of a Brachial Plexus Injury for Children?

Because this nerve damage affects movement and sensation in a child’s shoulder, arm or hand, it can have long-term repercussions to their physical and emotional quality of life. For many people, this type of birth injury can permanently change their ability to function as well as their confidence and outlook.

How Do Doctors Diagnose a Brachial Plexus injury?

In addition to conducting a physical examination on your baby, your doctor may recommend one or more of the following:

• X-ray to determine if the baby’s neck or shoulders show evidence of fractures or other injuries.
• Electromyography (EMG) to evaluate electrical activity in the muscles at rest and during contraction.
• Nerve conduction studies. These measure how well the nerve is functioning when a small amount of electricity is introduced.
• Magnetic resonance imaging (MRI) that uses magnetic fields and radio waves to produce detailed images of the baby’s body to identify areas of injury.
• Computerized tomography (CT). This scan uses several X-rays to generate cross-sectional images of the body. CT myelography gives a detailed picture of the spinal cord as well as all the nerve roots leading to it.

How are Brachial Plexus Injuries in Infants Treated?

The most minor instances usually clear up on their own without intervention. For more serious cases, the following interventions are recommended:

• Physical therapy, often consisting of exercises to promote range of motion, sensory awareness, flexibility and myofascial release. Massage and a home exercise plan are also often integral to PT.
• Neuromuscular electrical stimulation (NES). Usually not recommended until the child is three or above, this intervention involves applying alternating electrical currents to muscles in the affected area that increase blood circulation and can lead to improved function.
• Neurolysis. Chemicals are applied to the affected areas to relieve pain and to burn scar tissue off of the affected area that is causing pain or discomfort.
• Surgery. This most invasive form of treatment is usually not recommended unless there has been no improvement in three to six months. Types of surgery vary but can include nerve grafts, nerve transfer and nerve repair.
• Pain and muscle relaxant medications.

What is the Prognosis for a Brachial Plexus Injury?

This type of injury can be temporary or permanent. The severity and length of duration are impacted by the site of the injury, how extensively the nerves were damaged, the type of trauma the nerves sustained and any other conditions affecting the area. In general, the sooner a brachial plexus injury is diagnosed and treated, the more positive the outcome will be. In cases of severe injury where surgery is advised, neurologist generally like to perform the procedure when the baby is between four and nine months old to prevent the damage from becoming severe and permanent. In the most serious cases, surgery has only shown to be effective in 50 percent of patients, meaning that they are given full functioning in the affected area. Up to 90 percent of patients with less severe injuries for who surgery is recommended have a full recovery.

If you believe your baby has sustained a brachial plexus injury, time is of the essence. In addition to meeting with the medical professionals involved in the birth, consider discussing your concerns with an attorney who specializes in this type of personal injury. The potential short and long-term effects of this condition are too serious to underestimate or ignore.