What is Brachial Plexus Injuries?

The brachial plexus is a complex system of nerves located between the shoulders and neck. These nerves transmit signals between the spine and shoulders, arms, and hands, making them responsible for much of the muscle function and sensation in these areas.

This network of nerves can be damaged when it is stretched, compressed, or torn, typically when the head is tilted or stretched too far up and away from the shoulder. Injuries may affect all or only part of the brachial plexus nerve system.

Causes of Brachial Plexus Injuries

Brachial plexus injuries can occur at any time of life due to factors like shoulder tumors, trauma, inflammation, or puncture wounds that sever the nerves. 

Traumatic brachial plexus injuries are most likely to occur anytime the head is vulnerable to being unnaturally forced up and away from the shoulder, such as during:

• Impact sports
• Bike accidents
• Car and motorcycle accidents
• Difficult childbirths

Brachial Plexus Birth Injuries

When a baby’s brachial plexus is injured during the delivery process, it is considered a birth injury. Unlike birth defects, which occur prior to the baby’s birth due to factors like genetic mutations and certain medicines or toxins ingested by the mother, birth injuries happen during or just after birth, and they are often preventable. 

Birth injuries are more likely to occur if the medical provider breaches their duty of care by either failing to properly monitor the mother or child for signs of distress or by inflicting physical trauma with birth assisting tools like forceps. However, birth injuries can also occur without any evidence of medical negligence, and brachial plexus injuries in particular are especially likely to occur if the baby’s shoulders are trapped in the birth canal.

Risk Factors for Brachial Plexus Birth Injuries

Brachial plexus injuries are more likely to occur at birth when:

• The baby’s shoulder or shoulders are stuck behind the mother’s pelvis (a condition called shoulder dystocia)
• The mother has a narrow or small pelvis
• The baby is larger than average
• The delivery is not progressing without external assistance (from birth assisting tools like forceps or vacuums)
• The mother has diabetes
• The mother is delivering twins
• The mother has a history of births that resulted in brachial plexus injuries
• The labor is prolonged
• The baby is presenting feet-first (breech) at birth

Although these risk factors make brachial plexus injuries more likely, according to the Cincinnati Children’s Hospital, more than half of brachial plexus injuries occur with no known risk factors. 

If you believe that your baby may have sustained a brachial plexus injury during birth, then get in touch with an experienced birth injury can help you determine whether medical negligence was a factor. You may be eligible for compensation to help with any recovery costs associated with the treatment of brachial plexus injuries. 

The birth injury attorneys at Murphy Falcon & Murphy have helped many Baltimore families file birth injury claims, and we can help you too. Turn to our experienced team to learn more about your legal options today. Contact us to schedule your free consultation and tell us about your case.

Types of Brachial Plexus Injuries

Brachial plexus injuries are often split into categories based on the pattern of nerves involved and on the type of injury to the nerves. These types of injuries include:

Neurapraxia: Stretched but not Torn

Neurapraxia injuries occur when the nerves of the brachial plexus have been stretched, but are not torn. This injury occurs outside of the spinal cord. 

This is the most common type of brachial plexus injury, and the affected nerves can usually recover on their own within three months. 

Rupture: Torn (not at the Root)

Rupture injuries are sustained when the nerves of the brachial plexus are stretched so far as to be torn, but they are not torn where they attach to the spine — thus, as with neurapraxia injuries, the injury occurs outside of the spinal column.

These are another common form of brachial plexus injuries, and they may require direct surgical repair to restore function and sensation. 

Avulsion: Torn (at the Root)

Avulsion injuries occur when the brachial plexus nerves are torn out from the spinal cord. Fortunately, this is not as common — according to the Children’s Hospital, only about 10 to 20% of all brachial plexus injuries are avulsive. Typically, these are the most serious type of brachial plexus injury, since they occur at the spinal cord itself, and the damaged tissues cannot be surgically repaired directly. Instead, they must be surgically replaced with nerve transfers. 

If the nerves to the diaphragm are injured, there may be difficulty with breathing. If there are other symptoms including droopy eyelids on the affected side, it may be indicative of a more serious injury such as Horner’s Syndrome. 

Neuroma: Scar Tissue Interference

These types of brachial plexus injuries occur when the nerve has tried to heal itself, but scar tissue has formed around the injury site and is pressing against the nerve, potentially causing pain and interfering with the nerve’s ability to send and receive signals to and from the brain. 

To restore nerve function, surgical treatment may be needed. This will typically entail reconstruction of the nerve and/or secondary tendon transfers. 

Symptoms of Brachial Plexus Injuries

How can you tell if your baby has a brachial plexus injury? Depending on the severity of the injury, nerve damage in the brachial plexus typically causes symptoms including:

• A limp, paralyzed, or awkwardly-positioned arm on the affected side
• Lack of muscle control in the affected wrist, hand, or arm
• Lack of sensation in the affected arm or hand
• Pain in the affected areas

Sometimes, nerve damage is accompanied by bone fractures to the clavicle or humerus. Fortunately, babies’ bones are very resilient, and fractures typically heal within 10 days. Additionally, the Children’s Hospital claims that babies do not experience much pain since their nerves behave differently than adults’. They estimate that while adult brachial plexus injuries regularly cause debilitating pain, only roughly 4% of babies seem to experience severe pain from brachial plexus birth injuries. 

However, just because your baby did not experience pain during the birth does not mean that you are ineligible for damages related to birth injuries. Some brachial plexus injuries will take months to heal and may require expensive treatments like physical therapy and corrective surgeries. Contact our accomplished Baltimore birth injury lawyers at Murphy Falcon & Murphy to learn more about your options for pursuing justice and fair compensation. 

Diagnosing Brachial Plexus Injuries

The only way to know for certain whether or not your child has a brachial plexus injury (and if so, how serious the injury is), is to seek the advice of a qualified medical professional. Physical exams (with medical histories) can be scheduled with a primary care doctor, but if problems persist beyond six weeks after birth, then it may be time to see a pediatric orthopedist or brachial plexus specialist. 

To diagnose brachial plexus injuries, doctors may utilize:

• Physical examinations
• Special imaging through MRIs or nerve conduction studies (though these tests are less reliable for babies than they are for adults)
• X-rays (if the doctor suspects that the child also has a fracture)

Conditions Related to Brachial Plexus Injuries

Erb’s Palsy

Erb’s palsy makes up about 75% of all brachial plexus injuries, and it affects the C5, C6, and sometimes C7 nerves. What this means is that the baby may have good hand function, but lacks full movement or motor control of the arm itself. Often, the affected arm is turned inward with the wrist fully bent, and the infant’s biceps and deltoid muscles are too weak to bend the elbow or lift the arm at the shoulder, resulting in an arm that hangs loose and straight at the baby’s side, and an unstable shoulder joint. 

Erb’s palsy can affect sensation, movement, and growth of the affected arm, but it can typically be treated with daily physical therapy and sometimes surgery. Home therapy is generally begun at three weeks old to prevent muscle atrophy, stiffness, and shoulder dislocation.

Global Palsy

Global palsy (also known as “total plexus involvement”) represents a severe type of birth injury in which all five of the brachial plexus nerves (C5 – T1) are involved. The Children’s Hospital estimates that these types of injuries make up 20 to 30% of all brachial plexus birth injuries, and they are usually associated with avulsions (being torn from the spinal column by the nerve roots). 

Usually, global palsy presents with no movement in the baby’s shoulder, arm, or hand, and they may not have any sensation throughout the arm. To check whether a baby has feeling in an arm, a doctor may place ice on or pinch the affected area. If the baby doesn’t react, there may be partial paralysis in the arm.

Other clues to global palsy include any type of blood flow or motion problems affecting the upper arm, since nerve damage can affect the circulatory, nervous, and muscular systems alike.

Horner’s Syndrome

Horner’s Syndrome represents approximately 10 to 20% of brachial plexus injuries. It typically occurs after an avulsion ruptures the T2 to T4 nerves, and it can disrupt nerve signals to parts of the infant’s face. Because of this, it usually presents with:

• Ptosis (droopy eyelid)
• Slight elevation of the lower eyelid (sometimes called upside-down ptosis)
• Miosis (a persistently small pupil)
• Anisocoria (a noticeable difference in pupil sizes between the two eyes)
• Weak or delayed reactions from the affected pupil in response to light changes
• Anhidrosis (diminished sweat production on parts of the face)
• Sunken appearance of the affected eye
• Lighter iris color in the affected eye

Timely treatment of the damaged nerves can often restore normal function and appearance.

Klumpke’s Palsy

Klumpke’s palsy is a rarer form of brachial plexus birth injury which affects the first thoracic nerve (T1) and the eighth cervical nerve (C8) either before or after they have joined to form the lower trunk of the brachial plexus system. This results in partial paralysis of the baby’s hand and forearm as signals from the hand’s intrinsic muscles and the flexors of the wrist and fingers are disrupted.

The severity of the nerve damage will affect how Klumpke’s palsy presents. In its most severe manifestation, Klumpke’s palsy will cause a “claw hand,” where the affected forearm hangs loose and the wrist and fingers are perpetually tightened. 

According to the Birth Injury Guide, in most cases – and with proper treatment – babies affected by Klumpke’s palsy can recover 90 to 100% of their arm and hand function within six months.

Treatment for Brachial Plexus Injuries

Many brachial plexus injuries will heal with time and appropriate treatment, and the long-term outlook is generally positive. However, it is important to ensure your baby gets the correct treatment.

If you suspect medical negligence may have played a part in causing the injury, then you may be eligible for damages that can help to cover the costs of restorative treatments and surgeries. Contact our Baltimore birth injury attorneys to discuss your case and learn more about your options. 

Observation and Natural Recovery

An estimated two-thirds of brachial plexus injuries may heal on their own in three to four months without treatment. During this time, you are advised to bring your infant in for ongoing monitoring by a medical professional. They will be able to assess the success of your baby’s improvement or recovery with regular examinations. 

The brachial plexus nerves can regrow from the neck down the arm at a rate of roughly one millimeter per day, or one inch per month. If the motor and sensory nerve fibers are able to fully reattach at their original motor and sensory targets between the spine and extremities, the baby will likely make a full recovery. Mixed or incomplete recovery may occur if the nerves are unable to fully reattach.

Natural recovery can be aided with gentle range of motion exercises, prescribed by a doctor and performed by parents or guardians. For children who cannot make a full recovery naturally, more focused physical therapy or surgery may be recommended.

Physical Therapy

Physical therapy, including range of motion exercises, strengthening exercises, neuromuscular electrical stimulation, joint mobilization, aquatic therapy, Kinesio taping, and orthoses, may be used to encourage recovery. 

Depending on the severity of the brachial plexus injuries, physical therapy exercises may be performed at home by the parents or guardians, or they may be performed in a clinic by a qualified physical therapist. Maintaining good muscle and joint movement is essential to successful recovery.

Botox® Injections

In some cases (especially where the shoulder has been adversely affected), Botox® may be used to help restore joint motion, rebalance muscles, or prevent shoulder dislocations and contractures. 

Surgery

Babies who continue to have complications from brachial plexus injuries three to six months after birth may benefit from surgical treatment. The Children’s Hospital reports that less than half of all children with brachial plexus birth injuries will need nerve surgery, but for those that do, possible surgeries include:

Microsurgery

Microsurgery makes up 10 to 12% of all brachial plexus injury surgeries, and it is intended to reconstruct the injured nerves via nerve grafts and transfers. This surgery is recommended for children between the ages of three and nine months, and is usually not beneficial for children who are already older than one year. 

Osteotomy

This procedure cuts and reorients the bones of the arm in order to improve upper extremity function. It’s most commonly performed on the forearm or humerus, and babies will be placed in a cast for recovery.

Tendon Transfers

Tendon transfers can allow healthy muscles to help weaker or compromised muscles return to normal function. This entails removing a tendon from its normal attachment on the muscle and reattaching it at a separate location. Tendon transfers are most commonly performed on the shoulder to improve the child’s ability to raise their arm, but they may also be done in the forearm, wrist, or hand to improve precise motor functions. As with osteotomies, this surgery usually requires the baby to wear a cast for four to six weeks after the operation.

Capsulorrhaphy

Capsulorrhaphy, also known as “open reduction of the shoulder joint,” is an operation that restores the shoulder joint to its proper position and tightens the loose tissue around it to stabilize the joint and prevent further dislocations.

Free Muscle Transfers

In the rare cases when there are no eligible muscles in the arm or hand to replace dysfunctional muscles, an extensive surgery called a free muscle transfer may be performed. This entails transferring muscles from elsewhere in the body (usually the leg muscles) and reconnecting blood vessels and nerves under a microscope.

With time and proper treatment, most children with brachial plexus injuries will see favorable outcomes and improved long-term function.

Trust Murphy Falcon & Murphy With Your Birth Injury Case

If you believe that your child may have sustained a brachial plexus injury at birth, then contact the birth injury lawyers at Murphy Falcon & Murphy, a Baltimore-based personal injury law firm. Regardless of the severity of the injury or the suspected cause, our attorneys can help you determine whether or not you are eligible to pursue damages.

We understand that finding out your child may have a birth injury can be a painful experience for the whole family, and we want you to know that you can trust our team to act with compassion, discretion, and professionalism as we fight to defend you and your child’s rights. We have the experience, knowledge, and resources to help you secure a favorable outcome and a brighter future. 

Contact us online or by phone to request your free initial consultation. We look forward to discussing your case.