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You may never have heard of brachial plexus birth injuries, but they are not uncommon; one to three out of each 1,000 babies born suffers some kind of brachial plexus birth palsy (BPBP). The group of injuries known as BPBP can affect shoulder, arm, wrist and hand function and movement, and can also cause a lack of sensation to the affected limb or area. The damage done by BPBP can have lifelong effects.
The brachial plexus is the name for a group of nerves that allows the shoulder, arm, wrist, and hand to communicate with the spinal cord. As such, any damage to the brachial plexus network can impact the function of the muscles, making it difficult to lift and bend the arm or to straighten and lower it. The amount of impairment depends on the type and location of the damage done to the brachial plexus.
From the least severe to the most severe, the possible nerve trauma types are:
Once part of the brachial plexus is damaged, certain conditions can occur:
Because the intensity of the nerve injury can run from mild to severe, and the location of problems can differ because of the specific nerve or nerves involved, symptoms can vary widely. A common sign of Erb’s palsy is a stiff arm that turns inward, with a bent wrist and extended fingers. Serious damage can mean a limp or completely paralyzed arm. With Klumpke’s palsy, the arm may position itself differently, and the fingers and hand may be able to operate even when the arm’s movement is limited.
Symptoms are often noticed at birth, or soon thereafter:
When symptoms are present, diagnosis usually involves a physical examination, testing the Moro reflex, and X-rays of the injured area. Often special tests are ordered. These can include an electromyogram (EMG), which measures muscle problems due to the nerve injury, and a nerve conduction study (NCS), which determines the distance that electrical signals are traveling along the nerves.
Mild cases, such as neuropraxia, can sometimes be treated with gentle physical therapy, stretching, and massage. More severe cases, such as an avulsion, usually require surgery. However, even with a case that appears mild at first, if range of motion and muscle strength and function do not recur within the first three to six months, other treatments may be indicated. Surgery can be needed if nerve damage either does not heal or if it is extensive.
A number of things can go wrong during any baby’s delivery. One of the most common reasons for infant brachial plexus damage is excessive stretching and force used on the part of the doctor or other medical personnel. The excessive force is often caused by the use of forceps or vacuum extraction.
Additional birth situations that can make brachial plexus injuries more likely include:
Sometimes a Caesarean section (C-section) is needed to deliver an unusually large baby or to prevent harm to the infant. If it can be shown that the doctor should have performed a C-section but didn’t, and a brachial plexus injury occurred, it could be argued that the child suffered trauma due to malpractice.