Brachial plexus birth injury (BPBI), the leading cause of infants’ upper extremity paralysis, is a condition affecting the nerves responsible for muscle control and sensation in the shoulder, arm, forearm, hand and fingers. It is the single most common birth injury and occurs in 1 to 3 per 1,000 births.
Infants who have mild nerve injuries may recover, but about 30% of infants with BPBI suffer more severe injuries and permanent neurologic damage that require lifelong care.
Among contributing factors which leave the child with permanent disability/paralysis are improper obstetrical maneuvers to release the shoulder from being stuck under the Mom’s pubis during delivery.
In babies, the brachial plexus nerves in the shoulder are vulnerable during birth. Larger babies in difficult vaginal deliveries are particularly prone to this injury, as are babies of mothers who have gestational diabetes or whose labor lasts an unusually long time.
Brachial plexus injury at birth generally takes one of two forms. One is Erb’s palsy which causes numbness and loss of motion around the shoulder and an inability to flex the elbow, lift an arm or bring objects to the mouth. The other is Klumpke’s palsy, a loss of motion and/or sensation in the wrist and hand, such as being unable to move fingers.
Some children with brachial plexus birth injuries recover on their own, and most children will regain all or most of their normal function with physical and occupational therapy. Others will require surgery.
Early diagnosis and treatment are important. Assuming the injury occurred during birth, the best time for surgery is when the child is between 4 and 9 months. Waiting longer than a year can limit the level of function a surgery might restore.
Because nerves heal slowly, brachial plexus injury recovery after surgery can take several weeks to months. During this time, regular physical therapy appointments are often necessary to prevent muscle atrophy.
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