UNDERSTANDING BRACHIAL PLEXUS INJURIES

A brachial plexus injury (Erb's Palsy) is a nerve injury. The nerves that are damaged control muscles in the shoulder, arm, or hand. Any or all of these muscles may be paralyzed. Children with brachial plexus injuries are affected in different ways. Here are some examples:

• Some children have no muscle control and no feeling in the arm or hand.
• Some children can move their arms, but have little control over the wrist and hand
• Other children can use their hands well but cannot use the shoulder or elbow muscles.

Your child's disability depends on which nerves are injured and how severely they have been damaged.

What is the Brachial Plexus?

The brachial plexus is a network of nerves. It conducts signals from the spine to the arm and hand. These signals cause the arm and hand muscles to move. (Brachial means arm, and plexus refers to a network of nerves.)

What Causes Brachial Plexus Injuries?

Although injury can occur at any time, most brachial plexus injuries happen during birth. Many babies with brachial plexus injuries are larger than average at birth. However, newborns of all sizes, including premature babies, can have these injuries. About 1 or 2 babies in 1,000 suffer brachial plexus injuries at birth. About 1 in 10 of these need treatment. The possible treatments are exercise and therapy, or surgery plus therapy.

Brachial Plexus Injuries

There are four types of nerve injuries:

1. An avulsion: the nerve is torn from the spine.
2. A rupture: the nerve is torn but not where it attaches to the spine.
3. A neuroma: the nerve has tried to heal itself, but scar tissue has grown around the injury. The scar tissue puts pressure on the injured nerve. As a result, the nerve cannot conduct signals to the muscles.
4. Praxis: the nerve has been damaged but not torn. These injuries heal on their own. If your child has praxis, you should see improvement within 3 months.

One or more of the nerves in the brachial plexus may be injured. The nerves may have the same or different kinds of injuries. Because the injuries cause the same symptoms, it is difficult to know what kind of injury has occurred.

Surgery for Brachial Plexus Injuries

Surgery may help children who do not recover by the age of 5 months. Nerve surgery is done by a pediatric neurosurgeon. The purpose of surgery is to improve how well the arm functions. Nerve surgery is most effective when it is done between the ages of 5 and 12 months. After children turn 1 year old, the surgery may not be as successful.

For some children, neurosurgery is not recommended or is not successful. In these instances, other procedures can be done to transfer muscles and tendons. This surgery is done by a plastic surgeon when the child is older.

Exercises for Brachial Plexus Injuries

We recommend daily exercises that help to keep the muscles and joints moving normally. They are called range of motion exercises. If your child is not able to use muscles in the arm and hand, these muscles will stay weak. The arm may not grow normally, and you may feel tightness in some muscles and joints. A joint that stays in the same position all the time can actually "freeze". Exercises keep the muscles and joints flexible. When the nerves start working better, the muscles and joints will be ready to work. An occupational or physical therapist will work with your child. The therapist will also help you (the parent) learn to do the exercises. Most parents need to do the range of motion exercises at home with their children two to three times a day for several years.

Reprinted with permission from
United Brachial Plexus Network
1610 Kent St.
Kent, OH 44240