Brachial Plexus Birth Injury

Brachial Plexus Birth Injury (BPBI) is a condition that occurs when the network of nerves controlling muscles and sensation in the shoulder, arm, and hand is damaged during childbirth. This injury can result in varying degrees of weakness, loss of movement, and sensation in the affected arm, impacting the child’s ability to perform daily activities. BPBI can occur due to several factors, including difficult delivery, shoulder dystocia, or excessive pulling during birth. The severity of the injury ranges from mild stretching of the nerves to severe cases where the nerves are torn or detached from the spinal cord.

What is Brachial Plexus?

The brachial plexus is a complex network of nerves that originates from the spinal cord in the neck (cervical region) and extends through the shoulder into the arm. This network transmits signals from the spinal cord to the shoulder, arm, and hand, enabling both motor and sensory functions. The brachial plexus is crucial for the movement and sensation of the entire upper limb.

Structure of the Brachial Plexus

Roots: The brachial plexus begins with five nerve roots that emerge from the spinal cord: C5, C6, C7, C8, and T1.

Trunks: These roots converge to form three trunks:

• Upper trunk (C5 and C6)
• Middle trunk (C7)
• Lower trunk (C8 and T1)

Divisions: Each trunk splits into an anterior and a posterior division, creating six divisions in total.

Cords: The divisions regroup to form three cords:

• Lateral cord (formed from the anterior divisions of the upper and middle trunks)
• Posterior cord (formed from all three posterior divisions)
• Medial cord (formed from the anterior division of the lower trunk)

Branches: These cords then give rise to the major nerves of the arm, including:

• Musculocutaneous nerve
• Axillary nerve
• Radial nerve
• Median nerve
• Ulnar nerve

Functions of the Brachial Plexus

• Motor Functions: The brachial plexus controls the muscles that allow for a wide range of movements in the shoulder, arm, forearm, and hand. This includes lifting, pulling, pushing, and fine motor skills like writing.
• Sensory Functions: It provides sensory innervation, which allows for the sensation of touch, pain, temperature, and proprioception (sense of body position) in the upper limb.

What is brachial plexus birth injury?

A Brachial Plexus Birth Injury (BPBI) occurs when the brachial plexus nerves are damaged during childbirth. These nerves, which originate from the spinal cord in the neck and control movement and sensation in the shoulder, arm, and hand, can be injured due to various complications during delivery.

Types of Brachial Plexus Birth Injury

Brachial Plexus Birth Injuries (BPBI) are categorized based on the extent and nature of nerve damage. 

Here are the primary types:

Neurapraxia

Neurapraxia is the mildest form of BPBI, where the nerves are stretched but not torn. This type of injury disrupts nerve conduction without damaging the nerve fibers themselves. Neurapraxia is the most common type of BPBI and often heals on its own within a few weeks to months. During this time, the affected arm may exhibit weakness and reduced movement, but full recovery is highly likely with appropriate physical therapy and care.

Neuroma

A neuroma occurs when a nerve is stretched and some of the nerve fibers are damaged, resulting in the formation of scar tissue. This scar tissue can exert pressure on the healthy nerve fibers, impeding their ability to transmit signals effectively. Neuromas can cause varying degrees of functional impairment and pain. Treatment may involve physical therapy to maintain range of motion and, in some cases, surgical intervention to remove the scar tissue and improve nerve function.

Rupture

Rupture refers to a more severe type of BPBI where the nerve is torn apart, but not at its attachment to the spinal cord. This type of injury typically requires surgical repair to reattach the torn ends of the nerve or to graft a nerve from another part of the body to bridge the gap. Recovery from a rupture can be prolonged and may not always result in full restoration of function, depending on the extent of the injury and the success of the surgical intervention.

Avulsion

An avulsion is the most severe form of BPBI, where the nerve is completely torn away from its attachment to the spinal cord. This type of injury is often associated with significant and permanent loss of function in the affected arm and hand. Avulsions cannot heal on their own, and surgical options are limited. Nerve transfer procedures, where a healthy nerve is redirected to restore some function, are sometimes attempted, but the prognosis is generally poor.

Subtypes of Brachial Plexus Birth Injury or BPBI

Erb’s Palsy

Erb’s Palsy is a subtype of BPBI that affects the upper brachial plexus (C5-C6). This results in weakness or paralysis of the shoulder and upper arm muscles, often presenting with the characteristic “waiter’s tip” position where the arm hangs by the side and is rotated inward.

Klumpke’s Palsy

Klumpke’s Palsy affects the lower brachial plexus (C8-T1), leading to weakness or paralysis of the forearm and hand muscles. This can result in a claw-like deformity of the hand and impair fine motor skills.

Causes of Brachial Plexus Birth Injury

Brachial Plexus Birth Injury (BPBI) can occur due to various factors during the childbirth process. 

Here are the primary causes:

Difficult Delivery

A challenging or prolonged labor can increase the risk of BPBI. Conditions such as a large baby (macrosomia), maternal diabetes, or a narrow birth canal can contribute to a difficult delivery. When the delivery is complicated, excessive force might be applied to assist the baby through the birth canal, potentially stretching or tearing the brachial plexus nerves.

Shoulder Dystocia

Shoulder dystocia is a condition where the baby’s shoulder becomes lodged behind the mother’s pelvic bone after the head has been delivered. This situation can create significant tension on the brachial plexus nerves as attempts are made to free the shoulder and complete the delivery. The excessive pulling or lateral flexion of the baby’s head can stretch or tear the nerves, leading to BPBI.

Breech Delivery

In a breech delivery, where the baby is delivered feet or buttocks first, there is a higher risk of brachial plexus injury. The unusual positioning can lead to increased pressure and stretching of the baby’s neck and shoulder area as the head and shoulders pass through the birth canal, increasing the likelihood of nerve damage.

Use of Delivery Instruments

The use of delivery instruments such as forceps or a vacuum extractor can also contribute to BPBI. These tools are sometimes necessary to assist in the delivery of the baby, particularly in cases of prolonged labor or fetal distress. Improper use or excessive force can result in stretching or tearing of the brachial plexus nerves.

Maternal Factors

Certain maternal factors can increase the risk of BPBI, including maternal obesity, diabetes, and a history of difficult or prolonged deliveries. These conditions can affect the size and positioning of the baby, as well as the dynamics of the delivery process, making it more likely for a brachial plexus injury to occur.

Rapid or Precipitous Labor

While prolonged labor is a common cause, very rapid or precipitous labor can also lead to BPBI. In such cases, the baby’s passage through the birth canal is accelerated, which may cause sudden and severe stretching of the brachial plexus nerves.

Symptoms of Brachial Plexus Birth Injury

The symptoms of Brachial Plexus Birth Injury (BPBI) can vary widely depending on the severity and specific type of nerve damage. 

Here are the key symptoms to look for:

Lack of Movement

One of the most noticeable symptoms is a lack of movement in the affected arm. Infants with BPBI may not move their shoulder, arm, or hand on the injured side. The arm might lie limp or hang loosely, and the baby may show little or no voluntary movement in the arm.

Weak Grip

A weak grip on the affected hand is a common symptom of BPBI. This can be particularly evident when comparing the grip strength between the injured and uninjured hands. Infants may have difficulty grasping objects or exhibit a noticeably weaker grip on the injured side.

Abnormal Arm Positioning

The arm might be positioned abnormally due to muscle weakness or paralysis. For example, in Erb’s Palsy (a type of BPBI affecting the upper brachial plexus), the arm may be held close to the body with the elbow extended and the wrist flexed, often referred to as the “waiter’s tip” position.

Absence of Moro Reflex

The Moro reflex, or startle response, is typically absent or diminished on the affected side. Normally, when an infant is startled, both arms will extend outward and then retract. In cases of BPBI, the arm on the injured side may not move or may move less than the uninjured side.

Muscle Weakness

Muscle weakness in the shoulder, arm, or hand can be a clear indication of BPBI. This weakness can range from mild to severe, depending on the extent of nerve damage. The muscles may be completely paralyzed.

Sensory Deficits

There may be a loss of sensation or abnormal sensation in the affected arm. Infants with BPBI might not respond to touch, temperature changes, or pain in the injured arm, indicating sensory nerve involvement.

Pain

Although less common in newborns, some infants with BPBI may experience pain or discomfort in the affected arm. This can manifest as excessive crying or irritability, especially when the arm is moved.

Arm and Hand Deformities

In cases of severe nerve damage, there may be noticeable deformities in the arm and hand due to muscle atrophy and contractures. This can lead to a claw-like hand or other deformities that impact the arm’s appearance and functionality.

Is Brachial Plexus Birth Injury responsible for neurological disorders in kids?

Yes, Brachial Plexus Birth Injury (BPBI) can lead to neurological disorders in children. The brachial plexus is a network of nerves that controls muscles in the shoulder, arm, elbow, wrist, and hand and provides sensation to these regions. Damage to these nerves during birth can result in various neurological and functional impairments. 

Neurological Disorders by Brachial Plexus Birth Injury (BPBI)

Here are some potential neurological disorders and complications associated with BPBI:

Erb’s Palsy

• Affected Nerves: Upper brachial plexus (C5-C6).
• Symptoms: Weakness or paralysis in the shoulder and upper arm, resulting in the characteristic “waiter’s tip” position where the arm hangs by the side and is rotated inward.
• Impact: Limits the range of motion and strength in the affected arm
  

Klumpke’s Palsy

• Affected Nerves: Lower brachial plexus (C8-T1).
• Symptoms: Weakness or paralysis in the forearm and hand, leading to difficulty with fine motor skills and hand grip.
• Impact: This may cause a claw-like hand deformity and reduced functionality in the hand and wrist.

Horner’s Syndrome

• Associated With: Severe lower brachial plexus injuries (T1).
• Symptoms: Drooping eyelid (ptosis), decreased pupil size (miosis), and lack of sweating (anhidrosis) on the affected side of the face.
• Impact: Affects the sympathetic nervous system, leading to facial asymmetry.

Chronic Pain

• Cause: Nerve damage and improper healing can lead to chronic neuropathic pain.
• Symptoms: Persistent pain in the affected arm, which can be debilitating.
• Impact: This can affect the child’s quality of life and daily activities.

Muscle Atrophy

• Cause: Lack of nerve stimulation to the muscles can result in muscle wasting.
• Symptoms: Decreased muscle mass and strength in the affected arm.
• Impact: Impairs arm functionality and can lead to asymmetry in muscle development.

Joint Contractures

• Cause: Prolonged immobility or improper positioning of the affected arm.
• Symptoms: Stiffness and loss of range of motion in the joints.
• Impact: Limits the ability to fully extend or flex the arm and hand.

Diagnosis & Treatments

Diagnosis of Brachial Plexus Birth Injury

Physical Examination

A thorough physical examination is the first step in diagnosing BPBI. Doctors will assess the infant’s range of motion, muscle strength, and reflexes in the affected arm. They will also look for any visible signs of nerve damage, such as abnormal arm positioning or lack of movement.

Imaging Tests

Imaging tests can help visualize the extent and location of the nerve damage.

Common imaging tests include:

• X-rays: To check for fractures or other bone-related issues that might accompany the nerve injury.
• Ultrasound: To assess the structures around the brachial plexus and identify any abnormalities.
• MRI (Magnetic Resonance Imaging): Provides detailed images of the soft tissues, including the brachial plexus nerves, to determine the extent of the injury.

Electrodiagnostic Studies

These tests measure the electrical activity of the muscles and nerves.

They include:

• Electromyography (EMG): Evaluates the electrical activity of muscles at rest and during contraction.
• Nerve Conduction Studies (NCS): Measure how quickly and effectively the nerves can send electrical signals. These tests can help determine the severity of the nerve injury and guide treatment decisions.

Treatments for Brachial Plexus Birth Injury

Physical Therapy

Physical therapy is often the first line of treatment for BPBI. It involves exercises to improve range of motion, muscle strength, and coordination in the affected arm. Therapists may also teach parents exercises to perform with their child at home to promote recovery.

Occupational Therapy

Occupational therapy focuses on improving the infant’s ability to perform daily activities. Therapists use activities and exercises to enhance fine motor skills, hand-eye coordination, and overall arm function. They may also recommend adaptive devices to assist with daily tasks.

Surgery

In severe cases of BPBI, surgery may be necessary. 

Surgical options include:

• Nerve Grafting: Transplanting a healthy nerve from another part of the body to replace the damaged brachial plexus nerve.
• Nerve Transfer: Redirecting a healthy, nearby nerve to restore function to the affected area.
• Muscle and Tendon Transfers: Moving muscles or tendons from one part of the body to another to improve arm function.
• Decompression Surgery: Relieving pressure on the nerves to enhance nerve function.

Botox Injections

Botox injections can help relax tight muscles and improve the range of motion in the affected arm. This treatment can be used in conjunction with physical therapy to maximize benefits.

Pain Management

For infants experiencing pain due to BPBI, pain management strategies may be implemented. This can include medications, nerve blocks, or other interventions to alleviate discomfort.

Long-Term Management

The prognosis for BPBI varies depending on the severity of the injury and the timeliness and effectiveness of treatment. Many infants with mild BPBI recover fully with early intervention and therapy. For those with more severe injuries, ongoing therapy, and potential surgical interventions may be necessary to maximize functional recovery. Regular follow-up appointments with healthcare providers are essential to monitor progress and adjust treatment plans as needed.

What Are The Long-Term Effects Of Brachial Plexus Birth Injury?

Brachial Plexus Birth Injury (BPBI) can have various long-term effects, depending on the severity and specific nerves involved.

Here are some potential long-term outcomes:

• Weakness or Paralysis: Some children may experience persistent weakness or paralysis in the affected arm, which can range from mild to severe.
• Limited Range of Motion: There might be a reduced range of motion in the shoulder, elbow, wrist, or hand. This can affect the child’s ability to perform daily activities.
• Muscle Atrophy: Muscles in the affected arm may become smaller due to lack of use or nerve damage.
• Abnormal Muscle Contractions: Children may develop abnormal muscle contractions or contractures, where muscles become permanently shortened, leading to joint deformities.
• Impaired Sensation: There can be a loss of sensation or abnormal sensations (such as tingling or numbness) in the affected arm.
• Developmental Delays: Children with BPBI might experience delays in reaching developmental milestones, particularly those involving motor skills.

FAQs

What is a Brachial Plexus Birth Injury?

A Brachial Plexus Birth Injury occurs when the network of nerves that send signals from the spine to the shoulder, arm, and hand (brachial plexus) is damaged during birth.

What causes Brachial Plexus Birth Injury?

BPBI is often caused by complications during delivery, such as shoulder dystocia, where the baby’s shoulder gets stuck behind the mother’s pelvic bone, excessive pulling on the baby’s head and neck, or breech delivery.

What are the symptoms of BPBI?

Symptoms can include weakness or paralysis in the arm, loss of sensation, limited range of motion, and muscle atrophy.

How is BPBI diagnosed?

BPBI is typically diagnosed through physical examination and imaging tests such as MRI, CT scan, or nerve conduction studies.

What are the treatment options for BPBI?

Treatment may include physical and occupational therapy, and in some cases, surgery to repair or graft nerves.

Seeking for help Birth-Related Injuries

If your child has suffered a Brachial Plexus Birth Injury and you believe it was due to medical negligence, you may be entitled to compensation. Our experienced legal team is here to help you understand your rights and navigate the legal process. We offer compassionate and knowledgeable support to ensure you receive the justice and resources your family deserves. Contact us at (312) 847-8984 today for a free consultation to discuss your case and explore your legal options.