What Is a Brachial Plexus Birth Injury?

A brachial plexus birth injury can significantly impact a newborn’s life and the lives of the entire family. While some of these injuries are unavoidable, others are caused by professional negligence (medical malpractice) during childbirth.

Understanding the Brachial Plexus

The brachial plexus is a network of nerves originating from the spinal cord at the base of the neck and extending through the upper chest into the armpits. These nerves control the muscles of the shoulders, arms, and hands, enabling both motor control and sensory functions. When these nerves are damaged during childbirth, it is called a brachial plexus birth injury.

Causes of Brachial Plexus Birth Injury

Injury to the brachial plexus is relatively common during childbirth, occurring in one to two newborns per 1,000 births. Brachial plexus birth injuries most often occur during difficult deliveries. Several factors can contribute to these injuries:

• Shoulder dystocia. Shoulder dystocia is the primary cause of brachial plexus injuries. It occurs when a baby’s shoulder gets stuck behind the mother’s pelvic bone during delivery, requiring additional force or maneuvers to deliver the baby.

• Large birth weight. Babies who weigh more than average at birth are at a higher risk because they are more likely to experience shoulder dystocia.

• Prolonged labor. Extended labor can increase the likelihood of complications, including brachial plexus injuries.

• Breech delivery. Babies delivered in a feet-first position (breech) are more susceptible to nerve injuries. Usually, a woman’s care team will attempt to turn the baby to a head-down position before delivery.

• Use of delivery instruments. Forceps or vacuum extraction can increase the risk of brachial plexus injuries due to the additional pressure exerted on the brachial plexus.

Types of Brachial Plexus Injuries

Brachial plexus injuries vary in severity, depending on the extent of the nerve damage. The main types include:

• Neurapraxia. The most common brachial plexus injury is neurapraxia, where the nerve is stretched but not torn. This can happen if the brachial plexus nerve root is pulled or compressed by the rotation of the baby’s head. It often resolves on its own within a few months, but it can cause pain and loss of sensation.

• Rupture. A forceful stretch can cause one or more of the nerve roots in the brachial plexus to tear partially or entirely. A brachial plexus rupture can be extremely painful and cause weakness or dysfunction of the baby’s shoulder, arm, or hand. Fortunately, some ruptures can be repaired with surgery.

• Avulsion. Avulsion is the most severe injury to the brachial plexus, where the nerve tears away from the spinal cord. Avulsions generally cannot be repaired or reattached surgically, leaving the baby with permanent weakness, paralysis, and loss of feeling in the affected arm.

• Neuroma. If nerve tissue is cut or torn during the birth process, scar tissue can form as it heals. That tissue, called a neuroma, can create a knot that presses on one of the brachial plexus nerves. This can cause pain, weakness, and loss of feeling. In most cases, doctors can surgically remove the scar tissue and take measures to prevent another neuroma from forming.

• Brachial neuritis. This relatively rare condition causes pain and loss of muscle control in the shoulder or arm. It can be progressive and worsen over time. Although doctors believe it can be related to a birth injury, they aren’t sure what causes the condition. While some cases respond to corticosteroids or surgical intervention, others are chronic.

Symptoms of Brachial Plexus Birth Injury

The symptoms of a brachial plexus birth injury can vary depending on the severity of the damage. Common symptoms include:

• Weakness or limpness in the affected arm.
• Lack of movement in the shoulder, arm, or hand.
• Absent reflexes in the affected arm.
• Decreased grip strength in the affected hand.
• Abnormal arm positioning, such as holding it close to the body with the elbow bent.

Since babies can’t articulate their perceived symptoms or comply with treatment protocols, managing the condition in infants can be challenging.

Diagnosing Brachial Plexus Birth Injury

Diagnosing a brachial plexus birth injury involves a thorough physical examination by a pediatrician or a specialist. The physician will assess the baby’s arm movements, muscle strength, and reflexes. In some cases, doctors use additional tests such as electromyography (EMG), nerve conduction studies, or imaging tests like MRI or ultrasound to determine the extent of the injury.

Treatment Options for Brachial Plexus Injuries

The treatment for a brachial plexus birth injury depends on the type and severity of the injury. Standard treatment options include:

• Physical therapy. Early intervention with physical therapy is crucial. It helps maintain joint flexibility and muscle strength, prevent stiffness, and promote recovery.

• Occupational therapy. Occupational therapists work with children to improve their fine motor skills and functional use of the affected arm.

• Surgery. Surgical intervention may be necessary in cases of severe nerve damage, such as ruptures or avulsions. Procedures can include nerve grafts, nerve transfers, or muscle/tendon transfers to restore function.

• Regular monitoring. Regular follow-ups with a healthcare provider are essential to monitor the child’s progress and adjust treatment plans as needed.

Long-Term Outlook

The prognosis for children with brachial plexus birth injuries varies. Many children with mild injuries recover fully with early intervention and therapy. However, severe injuries may result in lasting impairments and require ongoing treatment and support.

A brachial plexus birth injury can be a daunting diagnosis for parents. Understanding the condition and its treatment options can empower them to seek the best care for their child. Early diagnosis and intervention are crucial to minimizing the long-term effects and ensuring that children with brachial plexus injuries can lead active, fulfilling lives.

Consult an Experienced Birth Injury Lawyer

If your child suffered a brachial plexus birth injury, consult an experienced Michigan medical malpractice attorney. They can review your file and advise you of your options. You may be able to recover compensation if your child’s injuries were caused by the hospital or labor and delivery team’s negligence.