Brachial plexus birth injuries are a significant and often life-changing complication that can occur during childbirth. These injuries involve the delicate network of nerves responsible for controlling movement and sensation in a baby’s shoulder, arm, and hand. The impact of such an injury can range from temporary weakness to permanent disability, depending on the severity and timing of treatment.

This guide offers a comprehensive look at brachial plexus birth injuries, including their causes, symptoms, treatments, and long-term outcomes. It also explores when parents should consider consulting a lawyer if the injury may have been the result of medical negligence.

What are Brachial Plexus Injuries?

What is a Brachial Plexus Birth Injury?

The brachial plexus is a complex system of nerves that extends from the spinal cord in the neck and branches into the shoulder, arm, and hand. These nerves control vital motor and sensory functions in the upper limb, allowing for movements like lifting, grasping, and rotating the arm.

When a brachial plexus injury occurs during childbirth, it’s typically due to excessive stretching or compression of these nerves. This often happens in high-stress delivery situations, particularly when complications arise.

Different Types of Brachial Plexus Injuries

Brachial plexus birth injuries vary in severity and type:

Erb’s Palsy
This is the most common form of brachial plexus birth injury, involving damage to the upper nerves (C5 and C6). It results in difficulty moving the shoulder and bending the elbow, but the hand and wrist are usually unaffected.

Klumpke’s Palsy
This injury affects the lower nerves (C8 and T1) and can lead to weakness or paralysis in the wrist, hand, and fingers. While less common, it can significantly impact fine motor skills.

Global Palsy
A severe condition in which the entire brachial plexus is affected, leading to complete paralysis of the arm and often permanent impairment.

Nerve Avulsion
This is the most serious type of injury, where one or more nerves are torn completely away from the spinal cord. Recovery in such cases is challenging and may require advanced surgical techniques.

Understanding the type of injury helps parents and medical professionals develop an effective treatment and recovery plan.

 

Causes of Brachial Plexus Birth Injuries

Birth injuries affecting the brachial plexus are often associated with difficult or complicated deliveries. While many deliveries proceed without incident, certain conditions and risk factors increase the likelihood of nerve damage.

Shoulder Dystocia

Shoulder dystocia is a leading cause of brachial plexus birth injuries. It occurs when the baby’s shoulder becomes lodged behind the mother’s pelvic bone after the head has been delivered. This situation is a medical emergency, requiring quick action to deliver the baby safely.

When excessive force is applied to the baby’s head, neck, or shoulders during delivery, the brachial plexus nerves can become overstretched or torn.

Risk Factors

Several conditions increase the risk of brachial plexus birth injuries:

  1. Macrosomia (Large Baby Size): Babies weighing more than 8 pounds, 13 ounces are at greater risk because their size makes delivery more difficult.
  2. Prolonged or Difficult Labor: Lengthy labor can increase the likelihood of complications requiring forceful delivery techniques.
  3. Assisted Deliveries: The use of forceps or vacuum extractors can lead to increased pressure on the baby’s neck and shoulders, heightening the risk of nerve damage.
  4. Breech Delivery: When a baby is delivered feet or buttocks first, the brachial plexus nerves are more likely to sustain injury.
  5. Maternal Factors: Obesity, diabetes, or a small pelvis can contribute to delivery complications, increasing the risk of shoulder dystocia and associated injuries.

By recognizing these risk factors, medical professionals can take preventive measures, such as recommending a cesarean delivery in high-risk cases, to reduce the likelihood of brachial plexus injuries.

 

Symptoms of Brachial Plexus Birth Injuries

Symptoms of a brachial plexus injury are often evident immediately after birth. Parents and healthcare providers should be vigilant for signs that indicate possible nerve damage.

Physical Symptoms

  1. Limp Arm: The baby may keep one arm limp and unable to move. In some cases, the arm may hang at an unusual angle.
  2. Abnormal Positioning: The baby’s arm may be held in an internally rotated position with the wrist flexed.
  3. Weak Hand or Grip: A noticeable lack of grip strength in the affected hand.
  4. Asymmetrical Reflexes: The absence of the Moro reflex (startle reflex) on the injured side.

Behavioral Symptoms

  • Crying When the Arm is Moved: This can indicate pain or discomfort in the affected limb.
  • Reluctance to Use the Arm: Babies with a brachial plexus injury may avoid moving the injured arm entirely.

If these symptoms persist beyond a few days, it’s essential to seek medical evaluation to confirm the diagnosis and begin appropriate treatment.

 

Diagnosing a Brachial Plexus Birth Injury

Early diagnosis of a brachial plexus birth injury is crucial for determining the severity of the damage and deciding on the best course of action. A pediatrician or neurologist will typically perform a combination of physical examinations and diagnostic tests.

Diagnostic Process

  1. Physical Examination: Doctors assess the baby’s muscle strength, reflexes, and arm positioning to identify abnormalities.
  2. Imaging Studies:
    • X-rays: Used to rule out fractures or dislocations.
    • MRI or Ultrasound: Provides detailed images of the brachial plexus and surrounding tissues.
  3. Electromyography (EMG): Measures electrical activity in the muscles to assess nerve function and locate specific areas of damage.

The results of these tests guide the development of a treatment plan and help determine whether surgical intervention is necessary.

 

Treatment Options for Brachial Plexus Birth Injuries

The treatment plan for a brachial plexus birth injury depends on the type and severity of the damage. While many injuries heal with time and therapy, more severe cases may require surgical intervention.

Non-Surgical Treatments

  1. Physical Therapy: Involves gentle exercises to maintain the range of motion and prevent joint stiffness.
  2. Occupational Therapy: Focuses on strengthening muscles and improving coordination, particularly for hand and wrist movement.
  3. Splinting or Bracing: Supports the baby’s arm in a position that encourages proper healing and prevents further injury.

Surgical Treatments

Surgery is generally considered when there is little to no improvement after six months or if the injury is severe (e.g., nerve avulsion). Surgical options include:

  1. Nerve Grafting: Replacing damaged nerves with healthy ones from another part of the body.
  2. Nerve Transfer: Redirecting functioning nerves to restore movement in the affected area.
  3. Tendon Transfers: Moving tendons from unaffected muscles to compensate for lost function.

 

Rehabilitation and Long-Term Recovery

Rehabilitation is a critical component of recovery for brachial plexus injuries. It helps improve mobility, strength, and coordination in the affected arm, allowing children to lead more independent lives.

Rehabilitation Goals

  1. Restore Movement: Ensuring the arm can move freely without stiffness.
  2. Build Strength: Strengthening the muscles in the shoulder, arm, and hand.
  3. Enhance Coordination: Developing the skills needed for fine motor tasks like grasping and holding.

Long-Term Prognosis

The outlook for recovery depends on the severity of the injury:

  • Mild Cases: Often resolve within 3-6 months with therapy alone.
  • Severe Cases: May result in partial or permanent limitations, requiring ongoing therapy and adaptive tools.

Parents should remain committed to their child’s therapy regimen and work closely with medical professionals to track progress.

 

When to Contact a Lawyer

In some cases, brachial plexus birth injuries may result from medical negligence during delivery. If healthcare providers failed to anticipate complications or used improper techniques, families may be entitled to legal compensation.

Signs of Negligence

  • Inappropriate use of delivery tools like forceps or vacuum extractors.
  • Failure to recommend a cesarean delivery in high-risk situations.
  • Excessive force applied to the baby’s head, neck, or shoulders.

A qualified birth injury lawyer can help parents determine whether negligence played a role and guide them through the legal process.

 

Frequently Asked Questions About Brachial Plexus Birth Injuries

What is a brachial plexus birth injury?
A brachial plexus birth injury occurs when the network of nerves controlling the shoulder, arm, and hand is stretched, compressed, or torn during childbirth. This can lead to weakness, numbness, or paralysis in the affected limb.

What causes brachial plexus birth injuries?
The most common cause is shoulder dystocia, where the baby’s shoulder becomes stuck during delivery. Risk factors include large baby size, prolonged labor, breech delivery, and the use of delivery-assisting tools like forceps or vacuum extractors.

How are brachial plexus injuries treated?
Treatment depends on the severity of the injury. Mild cases often heal naturally with physical therapy, while severe injuries may require surgical intervention, such as nerve grafting or nerve transfer.

Can brachial plexus injuries heal on their own?
Many mild injuries resolve within the first 3-6 months without surgery. However, more severe injuries often require medical or surgical treatment to restore function.

Can I take legal action for a brachial plexus injury caused by medical negligence?
Yes, if the injury resulted from improper medical care during delivery, such as excessive force or failure to address complications, you may be entitled to compensation. Consult a birth injury lawyer for advice.

 

Contact Rafferty Domnick Cunningham & Yaffa Today

Brachial plexus birth injuries are a challenging but often manageable condition when addressed promptly. Early intervention, therapy, and, when necessary, surgical treatment can help children regain function and live full, active lives.

If you suspect that medical negligence contributed to your baby’s injury, take action. Contact Rafferty Domnick Cunningham & Yaffa to explore your legal options and secure the resources needed for your child’s care and recovery. Advocating for your child today can make all the difference for their future.