What Are Brachial Plexus Injuries?

The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to those nerves. These injuries occur most often with large babies who have a condition called macrosomia, which is a birth weight greater than 4000 grams (8 pounds 13 ounces). As macrosomia is often associated with diabetes in the mother during pregnancy, the importance of glucose screening and management of gestational diabetes is so important. However, a brachial plexus injury can occur with smaller babies and even during cesarean section if improper traction is applied to get the baby delivered.

The severity of a brachial plexus injury is determined by the type of damage done to the nerves. The most severe type, avulsion, is caused when the nerve root is severed or cut from the spinal cord from too much stretch. This condition may not be repairable. There is also an incomplete form of avulsion in which part of the nerve is damaged, and which leaves some opportunity for the nerve to slowly recover function or be treated surgically. Neuropraxia, or stretch injury, is the mildest type of injury and does not always damage the nerve underneath. This may heal on its own or be healed with nonsurgical treatment.

For these reasons, obstetricians are trained to carefully follow specific release maneuvers to allow the baby to deliver without excessive stretch that can rip the nerve from its roots.

What Are Common Causes of Brachial Plexus Injuries?

Common causes of brachial plexus injuries in adults are shoulder trauma, tumors, or inflammation. Loss of use in the affected arm can occur with or without obvious shoulder injury.

In infants, brachial plexus injuries may happen during birth if the baby’s shoulder is stuck during passage through the birth canal. This can occur if the baby’s shoulders are unable to fit through the birth canal, causing one shoulder to become wedged against the mother’s pelvic bone (symphysis pubis). When the shoulder is stuck, any traction that is used to pull the baby out stretches and can tear the nerve to the arm. Early recognition of babies at risk for this type of shoulder impaction is important to prevent brachial plexus injuries.

What Are The Symptoms of Brachial Plexus Injuries?

Brachial plexus injuries disrupt communication between the spinal cord and the arm, wrist and hand, so this is where symptoms appear. Symptoms of a brachial plexus injury may include a limp or paralyzed arm; lack of muscle control in the arm, hand, or wrist; and a lack of feeling or sensation in the affected arm or hand.

Are There Lasting Effects or Complications With Brachial Plexus Injuries?

Some brachial plexus injuries may heal without treatment and may not cause any lasting effects or complications. In fact, some children who are injured during birth improve or recover by 3 to 4 months of age. However, depending on the severity of the nerve injury, recovery of the affected arm and hand function may not be possible. In those cases, injuries and deficits can unfortunately be permanent.

An MRI examination of the brachial plexus is one of the best ways to identify the extent of the injury. In severe avulsion cases, nerve graft surgery is performed in an attempt to reconnect the nerve and avoid the lasting effects of braxial plexus injuries. If the avulsion is due to a birth injury, the optimal time for surgery in infants is between 4 and 9 months old. This is to maximize the level of function that may be restored with surgery. Other treatments for brachial plexus injuries include physical therapy and occupational therapy.

Contacting an Experienced Birth Injury Attorney

An experienced birth injury attorney with insights into brachial plexus injuries can help parents find out whether their child’s injury was a result of errors during prenatal evaluation and/or delivery. At Britcher, Leone & Sergio, you’ll find caring NJ brachial plexus injury lawyers who will guide you through the legal process to determine if you have a medical malpractice case. We know how to look for risk factors in prenatal care that should have predicted macrosomia and shoulder dystocia, as well as being familiar with the maneuvers intended to deliver the child without injury and understanding how the injury occurs. This combination of legal and medical expertise in birth injury cases makes a difference in determining those children whose conditions were caused by negligence.