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The brachial (brake-ee-al) plexus is a large network of nerves running from the neck to the arm. These nerves provide movement and feeling to the arm and hand. Brachial plexus palsy is weakness or paralysis in parts of the arm as a result of significant injury to the brachial
plexus, which can happen during childbirth. The most common type of brachial plexus palsy is called Erb's palsy.
Brachial plexus palsy may be caused during childbirth. Sometimes after the baby's head has been delivered, the shoulders sometimes get trapped inside the mother's pelvis. To free the shoulders, the head is tilted to the opposite side and this stretches the brachial plexus nerves. Brachial
plexus palsy can also be due to the baby's position inside the uterus, and in rare cases may occur during a Caesarean section.
The nerves that make up the brachial plexus carry electrical signals (instructions) from the brain to the arm, so that the arm and hand can feel and move. If nerves are injured, the muscles of the arm and hand may not receive all of the instructions from the brain. This may result in:
Your baby may also have other problems as a result of the injury, including:
In most cases, brachial plexus palsy will be noticed during routine checks in hospital after your baby is born. Your Maternal and Child Health Nurse may also pick it up. If you notice any of the signs of brachial plexus palsy, take your baby to the GP or paediatrician. They may involve a
specialised plastic surgeon and/or physiotherapist.
There is no single test to tell how serious the brachial plexus injury is. Your baby's doctors and physiotherapist will assess your baby's arm over a period of time. They will look for improvements in movement, function, shape and size.
Your child may be seen by a team including a plastic surgeon, orthopaedic surgeon, physiotherapist and occupational therapist. Once an assessment has been completed, a treatment and follow up plan will be provided to you which may include regular reviews, stretches, positioning,
splinting and referral to local services if required.
Most babies with brachial plexus injuries recover fully with minimal treatment. However, in rare cases, some children may require surgery for the nerves, muscles and bones.
If you have be prescribed exercises or splints by your therapists, you will be shown how to complete these and incorporate these into your baby’s daily routines (e.g. during bath time and dressing).
It is important to take extra care not to injure the affected arm. Because the feeling is reduced, your baby may not feel hot objects (i.e. burning) or pain. Therefore, they may not show distress and it can be difficult to tell if they are injured.
Will my child's arm always be weaker than the other arm or will it improve as my child grows older?
In most cases, a full recovery occurs within the first one to three months, but up to one quarter of babies will have ongoing function problems of the affected arm. With physical therapy, most children make a full recovery or are left with minimal impairment.
How likely is surgery to be successful?
Surgery is uncommon and is usually only used in children who do not recover (with full arm function) in the first three to nine months of age. Surgery is aimed at improving function but will not result in a perfect outcome.
Developed by The Royal Children's Hospital Plastic and Maxillofacial Surergy, Physiotherapy and Occupational Therapy departments. We acknowledge the input of RCH consumers and carers.
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