Neurosurgery - Patient Care and Treatment

Learn about causes, signs and treatments for brachial plexus injuries from Penn State Children’s Hospital Pediatric Neurosurgery team.

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Brachial plexus injuries

The brachial plexus is a bundle of nerves that conducts signals from the spine to the shoulder, arm and hand.

What causes brachial plexus injuries?

Most brachial plexus injuries happen during birth, although they can occur at any time. About two babies in 1,000 suffer brachial plexus injuries at birth. It usually happens when the baby is passing through the birth canal. The baby's shoulders may become impacted, causing the brachial plexus nerves to stretch or tear.

If this happens, your child will have a lack of muscle or sensory dysfunction in the affected limb. Many babies with brachial plexus injuries are larger than average at birth. However, newborns of all sizes can have these injuries, even premature babies who have stretched the plexus in prolonged labor or breech positions.

About one in ten babies with brachial plexus injuries need surgery. The others usually regain full nerve function through therapeutic exercises alone. Parents, physical therapists and physicians play a central role in recovery.

Brachial plexus injuries also happen when there is trauma to the neck or shoulders. They’re often caused by car and motorcycle accidents.

Signs and symptoms of brachial plexus injury

Children with brachial plexus injuries are affected in different ways.

  • Some children have no muscle control, and no feeling in their arm or hand.
  • Some children can move their arm, but have little control over the wrist and hand.
  • Other children can use their hand well, but cannot use the shoulder or elbow muscles.

Symptoms may include:

  • A limp or paralyzed arm
  • Abnormal limb posture
  • Lack of muscle control in the arm, hand or wrist
  • Lack of feeling or sensation in the arm or hand

Ask for a referral to our brachial plexopathy clinic if by three months of age your child cannot:

  • Squeeze your fingers
  • Bend their wrist
  • Bend and straighten their elbow
  • Raise their arm

Treatment for brachial plexus injuries is most effective when started between three and six months of age.

Types of brachial plexus injuries

There are four types of brachial plexus injuries:

  • Avulsion - where the nerve is torn from the spine. This is the most severe type of brachial plexus injury.
  • Rupture - where the nerve is torn, but not where it attaches to the spine.
  • Neuroma - the nerve has tried to heal itself but scar tissue has grown around the injury. This puts pressure on the injured nerve and prevents the nerve from conducting signals to the muscles.
  • Neuropraxia - where the nerves have been damaged or stretched. This is the most common type of brachial plexus injury.

Treatment options

Some brachial plexus injuries may heal on their own. However, there are two main treatments for brachial plexus injuries:

  • Physical or occupational therapy exercises
  • Surgery plus therapy exercises

Most children will regain full use of their motor function through therapy alone. For those children who do not regain their motor function by three to six months of age, nerve surgery can be an effective treatment.

Our brachial plexus care team: