What Are the Long-Term Effects from a Brachial Plexus Birth Injury?

Brachial plexus injuries are among the most common doctor-caused obstetric complications; they occur when the nerve roots become damaged through a traumatic delivery. These nerve roots (typically C5 and C6) control the arm and hand; injuries to them can result in partial or complete paralysis or muscle impairment of the upper arm. Although these injuries are not typically life-threatening, they may cause long-term issues.

Causes

• Babies who have a brachial plexus injury have damage to their nerve roots in their necks, which results in difficulty with arm movements. This damage typically occurs when babies have been manipulated excessively (especially in their necks or heads) during either a vaginal or cesarean birth. Sometimes the manipulation is necessary due to a birth complication such as shoulder dystocia or an excessively large baby. Nerves can take months to recover completely, extending the recovery time of a brachial plexus injury.

Frequency and Diagnosis

• Brachial plexus injuries occur in more than 1 in 1,000 births and are among the more common injuries sustained by babies at birth. Babies who have a brachial plexus injury present with excessive crying and poor results on reflex tests performed immediately after birth. After diagnosis, babies who have brachial plexus injuries are often referred to both specialists and physical therapists for assistance in treatment options.

Prognosis

• Prognosis for brachial plexus injuries are quite good; complete recovery is estimated to be between 75% and 95%. Most babies begin physical therapy in the first few weeks after birth. Nevertheless, some infants do experience long-term effects from a brachial plexus injury. These infants might need surgery or prolonged physical therapy to assist them with normal arm movements.

Long-Term Effects

• Because of the nature of a brachial plexus injury, babies that do not improve dramatically within 3 to 6 months after birth often have a poor prognosis for complete recovery. Affected babies might experience paralysis of the hand or arm, as well as possible lifelong arm weakness. Typically, this paralysis or weakness occurs in only 5% to 25% of babies who present with a brachial plexus injury at birth.

Treatment Options

• Initial treatment options include massage, gentle physical therapy and watchful waiting. Parents of babies affected by brachial plexus injuries should take care not to over-handle the baby, which might cause unnecessary pain and trauma. In the absence of complete recovery, treatment options include surgical repair of the damaged nerves and tendon transfers (in which a fully functioning tendon is transferred to the affected area).