Brachial Plexus Palsy: A Birth Defect of the Nervous System

Brachial Plexus Palsy involves injury to the brachial plexus, which are the nerves that originate from the upper spine that control the movement as well as the sensations in the arms. It causes weak or even paralyzed muscles in the shoulder, arm and hand. Obstetric Brachial Plexus Palsy is diagnosed at birth and can range from mild, where the condition will disappear by itself, to the need for physical therapy and occupational therapy and in some of the more serious cases, surgery. In any case, treatment needs to be started as early as possible.

The point at where spontaneous recovery becomes unlikely is the age of 4 months. Up to 4 months, the recovery rate is 75 percent. After 4 months, it decreases and by the 1 year mark, the chance of spontaneous recovery drops to 4 percent.

There are signs that can indicate the possibility of Obstetric Brachial Plexus Palsy. It can occur when the baby experiences shoulder dystocia, a condition when the baby's shoulder gets stuck under the mother's pelvic bone. When this happens, it is imperative that the doctor deliver the baby as fast as possible and in order to do that, he or she will have to pull the head or neck. Another indication is when the baby develops a droopy eyelid, a condition called Horner's Syndrome.

The chances of the injury going through a spontaneous recovery depends very much on the exact type of injury. The least severe is a simple stretch of the nerves where the injury is just to the outer walls of the nerves. There is another more serious stretching injury where the inner portion of the nerves are stretched as well. Another type of injury is called rapture where the nerve have been stretched to the maximum and end up being either partially or fully torn. In this case, EMG test will tell the surgeon if the nerves have grown back together. Depending on the results, the surgeon may perform a nerve graft. The third type of injury is called an avulsion and is the most serious. In this case, the nerve will have been pulled out of the spinal column. These nerves cannot be reconnected, but there have been cases where the nerves have been able to be connected to other nerves.

While no two cases are exactly alike, there is a general time line that can indicate the severity of the injury. If the spontaneous recovery happens within the first two months of life, no further action needs to be taken. However, if the child does not have hand, wrist or finger function at one month, something needs to be done. There is no instant fix. Nerves grow very slowly and even if surgery is done, it can take years for the child to get use of the arm. Non-surgical treatment can start as early as 3 weeks of age and involves range of motion exercises to keep the joints from becoming permanently stiff.

Sources

Your Orthopedic Connection

BPP Foundation

Brachial Plexus Center