Kids Health Info

Obstetric brachial plexus palsy Erbs palsy

  • The brachial 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. Injuries to the brachial plexus can happen during childbirth. 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

    If significant injury has occurred, the newborn baby's arm will be weak or paralysed. Other problems might include:

    • a broken collar bone (clavicle);
    • a broken upper arm bone (humerus);
    • Horner's Syndrome (the eyelid droops and the pupil of the eye is slightly smaller on the same side as the weak arm).

    Signs and symptoms

    The nerves that make up the brachial plexus carry the electrical signals (like '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 do not receive the instructions to move from the brain.  The arm does not move normally and the muscles will start to waste.  The baby may not have much feeling (such as temperature or pain) in the affected arm. 

    How can you tell how severe the injury is?

    There is no single test to tell how serious the brachial plexus injury is. Your child's doctor and physiotherapist will assess the arm over a period of time. They will look for improvements in movement.

    Time is the most important factor in the recovery of brachial plexus injuries. If the arm recovers quickly, the outcome should be better. 

    Treatment

    The Royal Children's Hospital Brachial Plexus Clinic is run by a team of plastic surgeons, orthopaedic surgeons, physiotherapists and occupational therapists. Your child will be seen by the surgeons as required and be reviewed by the physiotherapist on a regular basis.

    Babies who recover well in the first few months will be able to use their affected arm well. However, they may still have some ongoing muscle weakness. The movements of the weaker arm may not look the same as the movements of the other arm.

    Most children with brachial plexus injuries recover with physical therapy alone. About one in 10 children needs surgery to repair the damaged nerves.  The aim of surgery is improvement rather than a complete recovery.

    Care at home

    Physiotherapy should be started as soon as possible for a newborn baby with a brachial plexus injury. You will be given a range of movement stretches by your physiotherapist and you will be shown how to incorporate these exercises into your baby's daily routines, e.g. bath time, during dressing.  These exercises aim to keep the muscles and joints flexible and ready to work if and when the nerves and muscle function improve.

    It is important to take extra care against injuring the affected arm. Because the feeling is reduced, children may not feel hot objects (i.e. burning) or pain and therefore may not complain of an injury.

    Key points to remember

    • Obstetric brachial plexus injuries occur at birth.
    • About one in 10 children needs surgery to help improve function of the arm.
    • You will be offered an appointment with a physiotherapist and then booked into the Obstetric Brachial Plexus Palsy Clinic.
    • If upper limb splinting is required you will be referred to an occupational therapist.
    • It is important to continue the stretches and exercises at home for the best possible outcome.
    • About one in 10 children need surgery to help improve function of the arm.
    • If your baby does require surgery, they will have treatment with a physiotherapist afterwards to make sure they have the best possible outcome.

    For more information

     

    Produced by the Department of Plastic and Maxillofacial Surgery and the Physiotherapy and Occupational Therapy departments of the Royal Children's Hospital.  First upload: April 2005. Updated May, 2014.

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.