Brachial Plexus
What is Brachial Plexus?
The brachial plexus is a complex network of nerves that originate from the spinal cord in the neck and extend down into the arm. It is responsible for controlling the muscles and transmitting sensory information from the shoulder, arm, and hand. In children, injuries to the brachial plexus can occur during childbirth or as a result of trauma, and these injuries are known as brachial plexus birth palsy or brachial plexus injuries in children.
Brachial plexus birth palsy (BPBP) is a condition that occurs during childbirth when there is damage to the brachial plexus nerves. This can happen due to factors such as a difficult or prolonged delivery, shoulder dystocia (when the baby's head is delivered but the shoulders get stuck), or the use of excessive force during delivery. As a result, the child may experience weakness or paralysis in the affected arm, limited range of motion, and other related symptoms.
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Treatment for brachial plexus injuries in children varies depending on the severity of the injury. In some cases, these injuries can resolve on their own with time and physical therapy. More severe injuries may require surgical intervention to repair the damaged nerves or to improve function and mobility in the affected arm.
What Might Cause Brachial Plexus Injurie in a Child?
​Brachial plexus injuries in children typically occur due to trauma during childbirth or other accidents that involve the upper arm and shoulder area. The brachial plexus is a network of nerves that controls the muscles and sensation in the shoulder, arm, and hand. Injuries to the brachial plexus can range from mild stretching to severe tearing of the nerves. Several factors can contribute to brachial plexus injuries in children:
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Difficult Births: Brachial plexus injuries often occur during difficult or complicated deliveries. Factors that can increase the risk of injury include large birth weight of the baby, breech presentation (feet-first delivery), prolonged labor, and the use of forceps or vacuum extraction.
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Shoulder Dystocia: This occurs when the baby's head passes through the birth canal, but the shoulders get stuck behind the mother's pelvic bone. The obstetrician may need to apply additional pressure or maneuver the baby's head to release the shoulders, which can put stress on the brachial plexus.
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Macrosomia: Babies with high birth weights, often due to maternal diabetes, have a higher risk of brachial plexus injuries due to the increased force required during delivery.
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Maternal Factors: Conditions that affect the mother's pelvis, such as pelvic abnormalities, can contribute to the risk of shoulder dystocia and subsequent brachial plexus injuries.
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Assisted Delivery: The use of forceps or vacuum extraction during delivery can increase the risk of brachial plexus injuries due to the additional force applied to the baby's head and shoulders.
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Traumatic Falls or Accidents: In older children, brachial plexus injuries can occur due to traumatic falls or accidents that involve the upper arm and shoulder area. These injuries can range from mild to severe, depending on the force and mechanism of the trauma.
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Sports Injuries: Active children who engage in sports and activities that involve rapid arm movements or contact can be at risk for brachial plexus injuries if they experience a fall or collision.
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Tumors or Growth Abnormalities: In rare cases, tumors or growth abnormalities near the brachial plexus can compress or damage the nerves.
Severity of Brachial Plexus Palsies?
​Some kinds of brachial plexus palsies are more serious than others. ​
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If your child’s nerves are stretched, the brachial plexus palsy tends to be only short-term. It usually gets better quickly on its own.
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If your child’s nerves are torn, the brachial plexus injury is more serious. If they are torn partially, they may be able to grow back. But if the injury is too serious or if it scars a lot, the nerve fibers may not re-grow to reach the muscle. Without treatment, your child may not have enough strength to use their arm muscles in the future.
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If your child’s nerves are completely torn, or if nerves are torn away from the spinal cord, they will not be able to use their arm muscles without getting treatment.
What Symptoms Might Brachial Plexus Cause in Children?
Brachial plexus injuries in children can lead to a range of symptoms, which can vary depending on the severity and location of the injury. Common symptoms of brachial plexus injuries in children may include:
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Weakness or Paralysis: The child may have weakness or paralysis in the affected arm. The degree of weakness can vary, ranging from mild to severe.
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Limited Range of Motion: Children with brachial plexus injuries may have difficulty moving their arm and shoulder through their full range of motion. This can affect activities such as reaching, grasping, and lifting.
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Abnormal Posture: The affected arm may assume an abnormal posture due to muscle imbalances caused by the injury.
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Lack of Sensation: Some children may experience decreased sensation or numbness in parts of the arm, shoulder, or hand.
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Muscle Atrophy: Over time, muscle atrophy (wasting) and spasticity can occur in the affected arm due to lack of use and nerve signal disruption.
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Asymmetry: There may be noticeable differences in muscle size, strength, and appearance between the affected arm and the unaffected arm.
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Difficulty with Activities: Children with brachial plexus injuries may have challenges with everyday activities such as dressing, grooming, feeding, and playing.
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Pain: In some cases, there may be pain or discomfort associated with the injury, especially if nerve irritation or compression is involved.
What Treatments are Available for Brachial Plexus in Children?
Once your child’s has been diagnosed with brachial plexus injury, I (as a pediatric neurosurgeon in New York) will work with you, your child, and other medical professionals (e.g., pediatricians, orthopedic surgeons, neurologists, physical therapists, and occupational therapists) at Children's Hospital at Montefiore (CHAM) to formulate a customized treatment strategy tailored to your child’s needs. This customized treatment may utilize any one or a combination of the following interventions:
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Surgery: In cases where the brachial plexus injury is more severe and conservative treatments have not resulted in significant improvement, surgical intervention may be considered. Surgical options can include removal of scar tissue around the nerves, nerve grafting (replacing damaged nerve segments with healthy nerves from another part of the body), nerve transfers (reassigning healthy nerves to perform functions of the damaged nerves), or nerve decompression (removing tissue or structures compressing the nerves).
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Botox Injections: In some cases, doctors may use botulinum toxin (Botox) injections to temporarily weaken certain muscles that are overactive or causing abnormal movement patterns. This can help balance muscle activity and improve function.
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Therapy: This can include activities designed to stimulate nerve regeneration and enhance muscle activation and balance.
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Observation and Bracing: After birth, the injured nerves supplying the affected arm can achieve spontaneous recovery. It is crucial to monitor child’s shoulder function and degree of neurologic recovery by 4-6 months of age prior to offering surgical intervention.