Frequently Asked Questions

What happened to my child?

Most brachial plexus injuries happen during delivery of an infant. One or both of the baby's shoulders becomes stuck on the mother's pubic bone and the baby cannot get through the birth canal. This situation is called shoulder dystocia. The nerves in the shoulder (brachial plexus nerves) are stretched and sometimes torn as the baby is being delivered, resulting in an injury to the nerves. In most cases, there was a traumatic delivery, however it is possible to have a shoulder dystocia with subsequent brachial plexus injury during a seemingly "normal" delivery.

How do I care for my infant's arm?

Before you leave the hospital, you should be visited by a pediatrician and a physical or occupational therapist who will give you specific instructions regarding the care of your newborn's injured arm. Handle your infant carefully and be aware of how your baby's arm is positioned so that you do not cause further injury. The arm should not be pulled and you should never lift the child by the arms or under the arms. Always lift by the trunk, even when the child gets older. Many practitioners will recommend pinning the infant's sleeve to the front of the baby's shirt so that the arm is placed across the chest for the first few weeks. You should begin range of motion exercises as directed by your doctor or therapist to keep the baby's arm and hand muscles toned. A physical or occupational therapist will teach you these exercises so that you are able to perform them properly for your child. You will also want to educate family members and care-givers about handling the infant and helping with home therapy.

Your infant should be evaluated periodically by a physician or group of physicians specializing in treatment of brachial plexus injury.

Will my child's injury go away?

Some minor brachial plexus injuries may resolve completely with time. Other injuries will be permanent. The more severe the injury, the more likely there will be permanent damage. It was thought previously that the majority of bpi's go away, however current information seems to indicate that in many cases, the injury doesn't completely resolve but the child learns to compensate with other movements. Because the child can perform most tasks, it was assumed that the injury resolved. Many children with bpi will have some subtle signs of the injury throughout life during particular movements or they may experience a small deficit in range of motion of the affected arm. Others will have more severe problems as a result of the injury.

The severity of the injury depends on how badly the nerves were damaged and which nerves of the plexus are involved. There may be a stretch injury to a few nerves
in the plexus or there may be nerves that are completely torn from the spinal cord. Nerves that are stretched will heal better and faster than nerves that are torn. It may take some time but you should see slow and steady progress in your child's recovery of movement.

A brachial plexus specialist can determine which nerves were damaged by which movements the baby can make. They might not be able to determine the true extent of the injury without EMG studies or surgery.

How will a brachial plexus injury affect my child?

In general, a brachial plexus injury will limit sensation and movements of your child's shoulder, arm, wrist, hand and fingers. As an infant, this may make it difficult for your child to hold a bottle or crawl. Learning to sit and walk may be challenging because of balance problems from the affected side. Toilet training and dressing may be difficult for children with bpi as well as other self-care tasks. Sports, hobbies and occupations requiring good use of both hands may be difficult. Children and adults with bpi may experience pain, muscle aches, arthritis, scoliosis, dislocation and other joint, bone and muscle problems as a result of the injury. Most patients will have some degree of limited mobility and limited strength in the affected arm.

What can I do for my child?

The most important thing you can do for your child is to educate yourself about brachial plexus injury and become an advocate for your child. You may have to do some research to find knowledgeable healthcare providers who can give you the best treatment options. Be active in your child's care. Work closely with your physical or occupational therapists to learn ways you can help at home with your child's rehabilitation and daily exercises. Talk to other parents. Sometimes they can be the best source of support and information.