Brachial Plexus Palsy
What is Brachial Plexus Birth Palsy?
The brachial plexus is a network of nerves that comes from the spinal cord and controls muscle movements and sensation in the shoulder, arm and hand. Symptoms of brachial plexus palsy may include lack of active muscle control or abnormal sensation in the arm or hand. Brachial plexus injuries occur in about 1 of 2,000 births, but only about 10 percent of these babies need treatment. Injuries can occur at any time, but many occur when the nerves stretch or tear, particularly with a difficult delivery. Most cases may heal on their own.
Early Management
Early evaluation within the first one or two months of life is important to determine whether therapy or surgery is required. The site and type of brachial plexus injury determines the prognosis. Many children are born with brachial plexus palsy improve or recover by 3 to 4 months of age. Gentle range of motion exercises may be all that is necessary for some children. For the most serious avulsion and rupture injuries, there is no potential for recovery unless surgical reconstruction is done in a timely manner, usually around 3-6 months of age. The experienced team at Shriners Hospitals for Children — Houston® uses advanced microsurgical techniques such as neurolysis, nerve grants, and nerve transfers to repair the damaged nerves in order to restore some function to the arm. Regular follow-up appointments track an infant’s progress and ensure that the treatment plan is on track.
Later Management
Muscle imbalance or shortening of muscles (contracture) can develop in the joints of the arm. Limitations may include incomplete range of motion with one or more movements, weak muscles or decreased sensation through the arm. Therapy plays an important role in improving the overall function of the affected arm. Surgical procedures, when needed, are typically performed between the ages of 2 and 10. Some of the procedures we offer include arthroscopic surgery, shoulder reconstruction, rotational osteotomies, tendon transfers and Botox.
Medical and Family Support
The Shriners Hospitals for Children — Houston® brachial plexus team consists of experienced, internationally recognized orthopaedic surgeons, a pediatric neurologist, occupational therapists, physical therapists and child life specialists. Our team members work closely to deliver caring, individualized and comprehensive care to each child and family.
A brachial plexus injury is a life-long condition. Management often focuses on preventing or minimizing deficits and maximizing the child’s capabilities at home in the community. It is important to remember children are adaptable. We emphasize what your child can do. Positive reinforcement will help your child to develop a healthy sense of self-esteem and promote independence.