Children's Hospital Colorado

Brachial Plexus Injury/Brachial Plexus Birth Palsy

What is the brachial plexus?

The brachial plexus is a group of nerves between the neck and the shoulder. The nerves start in the spinal cord in the neck and then branch into the arm, forearm and hand. These nerves give the arm, forearm and hand their feeling and move the muscles in these areas.

What is a brachial plexus injury?

A brachial plexus injury is an injury to the brachial nerves. These injuries differ in how severe they are, how much they will improve and how long it will take for them to improve. The nerves can be harmed by pressure, being stretched, torn or even cut.

What is brachial plexus birth palsy?

Brachial plexus birth palsy is an injury to the brachial plexus nerves that usually happens when a baby is being born. Brachial plexus birth palsy is one of the most common injuries that can occur during birth. It is most common in difficult deliveries. It is important to know that the injury may have happened to deliver the baby safely and avoid more serious injury.

 

What are the signs and symptoms of brachial plexus birth palsy?

Babies and children with brachial plexus palsy may have:

  • Weakness in the arm or hand
  • Arm bent at elbow and held against body
  • Tightness
  • Decrease in feeling in the shoulder, arm or hand

How is a brachial plexus injury diagnosed?

A brachial plexus injury is often found during an exam right after birth. The doctor may order extra tests such as:

  • X-rays
  • Ultrasound
  • MRI
  • EMG (nerve tests)
  • CT Scan

The tests help diagnose the injury and help the doctor decide the best treatment.

What is the treatment for brachial plexus injury?

Our treatment plans include both surgical and non-surgical choices.

Therapy

Therapy often starts soon after a baby or child is diagnosed with a brachial plexus injury. Therapy may involve stretching and range of motion exercises, splinting or casting, and helping with normal every day activities.

Therapists at Children’s Hospital Colorado work with families/caregivers to create a specific program for each child under the direction of the doctors.

Botox Shots

The team may decide to have the rehab medicine doctor inject a medicine called Botox (botulinum toxin) to relax the muscles. If the muscles are relaxed, they are less likely to pull the joints into the wrong position. This procedure is done under general anesthesia (the child is put to sleep) in the operating room.

Surgery

The team may decide surgery is needed if the brachial plexus injury is severe. The surgeon will decide the best surgery for your child and talk about each of the choices with you (and your child if appropriate).

The surgeries most often done to fix a brachial plexus injury are:

  • Nerve graft or nerve transfer: using nerves from another place in the body to do the job of an injured nerve in the area of the brachial plexus injury
  • Muscle transfer or tendon transfer: moving a muscle or tendon from another area in the body to do the job of an injured muscle or tendon in the area of the brachial plexus injury
  • Osteotomy: a cut in the bone to change the position or shape of a bone

What does this condition mean long-term for my child?

Every child born with a brachial plexus injury is different. Some injuries are mild and some are severe. As the child gets older, their shoulder, arm and hand may look and move differently from a typical child. Some of these differences are more noticeable than others. The arm may be shorter, smaller and/or not move as well as the arm that was not injured.

At Children’s Colorado, our goal is to make sure that your child gets the best care possible to treat their brachial plexus injury.

Why choose Children’s Hospital Colorado for your child’s brachial plexus injury or brachial plexus birth palsy treatment?

Our team at Children’s Colorado provides a comprehensive, multidisciplinary approach to the care of your child. This means you have access to leading specialists from multiple departments who work together to treat your child.

Your child’s care team includes pediatric experts from:

  • Physical medicine
  • Rehabilitation
  • Orthopedic surgery
  • Occupational therapy
  • Nursing

Children with brachial plexus problems often need ongoing care throughout their lives. The team at the Brachial Plexus Clinic is committed to following patients through childhood and adapting their plan of care as needs change.

About our Hand and Upper Extremity Program

Our Hand and Upper Extremity Program team at Children’s Colorado provides a comprehensive, multidisciplinary approach to the care of your child. This means you have access to leading specialists from multiple departments who work together to treat your child.

Your child’s care team includes pediatric experts from orthopedic surgery, physical medicine, rehabilitation, occupational therapy and nursing.


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