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Brachial Plexus Injuries at Birth

November 16, 2020

The brachial plexus is the system of nerves between the neck and shoulders that controls muscle function in the chest, shoulder, arms, and hands. These nerves also are responsible for feeling in the upper limbs.

What is Brachial Plexus Birth Injury?

Brachial plexus birth injury is an injury to this system of nerves that happens in roughly one to three out of every 1,000 births. The nerves of the brachial plexus may be stretched, compressed, or torn in a difficult delivery. If this happens, a baby may lose muscle function or suffer paralysis of the arm.

Some injuries may impact all or only a part of the brachial plexus. Injuries to the upper brachial plexus (C5 or C6) disturb the muscles in the shoulder and elbow, while injuries to the lower brachial plexus (C7, C8, and T1) can afflict the muscles of the forearm and hand.

How Do Brachial Plexus Injuries at Birth Happen?

Brachial plexus injuries in newborns can happen if the birth is complicated by a breech or “bottom-first” delivery; if the mother has a very long labor; or if the baby’s shoulders are too wide to fit through the mother’s birth canal.

Also, babies delivered with excessive traction can suffer brachial plexus injuries. This can occur when an OB/GYN overreacts when the baby’s anterior shoulder becomes impacted on the mother’s pelvic bone.

What are the Common Types of Brachial Plexus Injuries?

Brachial plexus birth injuries are often classified by the type of nerve injury and the pattern of nerves involved. There are four types of nerve injuries: neuroma, stretch (neurapraxia), rupture, and avulsion. Here’s a description of each of these common types of brachial plexus injuries:

  • Stretch (neurapraxia) happens when a nerve has been stretched, but not torn. This injury occurs outside the spinal cord and the most common form of impacted nerve(s) may recover on their own usually within first three months of the child’s life.
  • A Rupture is a torn nerve and is the most common form of Brachial Plexus Injury. This torn nerve is not located where it attaches to the spine, but rather occurs outside the spinal cord. A rupture may require surgery to repair it.
  • Avulsion happens when nerve roots are torn from the spinal cord, and this injury occurs at the spinal cord. Avulsion is a less common form of brachial plexus injury (only 10 to 20% of cases). An avulsion can’t be surgically repaired directly. Instead, the damaged tissue must be surgically replaced with a nerve transfer procedure. An avulsion can also injure the nerve to the diaphragm, causing difficulty with breathing or causing a droopy eyelid on the affected side which may be a sign of a more severe injury, such as Horner’s syndrome
  • Neuroma is when the nerve has tried to heal, but scar tissue has formed and presses against the injured nerve or interferes with the nerve’s function. Neuroma may require nerve reconstruction and/or secondary tendon transfer surgery.

What are Other Forms of Brachial Plexus Injuries?

  • Erb’s Palsy involves the upper portion (C5, C6, and sometimes C7) of the brachial plexus. With this issue, the baby will have weakness in the shoulder and bicep muscles.
  • Total Plexus Involvement is present in about 20-30% of brachial plexus injuries. With total plexus involvement, all five nerves of the brachial plexus are involved (C5-T1). Plus, in total plexus involvement, a child may not have any movement at the shoulder, arm, or hand.
  • Horner’s Syndrome can be found in about 10-20% of injuries. It usually is associated with an avulsion (where nerve roots are torn from the spinal cord). The sympathetic chain of nerves has been affected—usually in the T2 to T4 region. A child may have a drooping eyelid (ptosis), a smaller pupil of the eye (miosis), or diminished sweat production in part of the face (anhydrosis). A child with Horner’s Syndrome may have a more severe injury of the brachial plexus.
  • Klumpke’s Palsy is rarely present in babies or children, and involves the lower roots (C8 and T1) of the brachial plexus. Klumpke’s Palsy typically impacts hand muscles.

Can I Sue For Brachial Plexus Injuries?

Yes. If your child suffered a brachial plexus birth injury due to the actions taken by an OB/GYN or other medical professional, it may be medical malpractice. A brachial plexus injury lawsuit is the legal way to sue and attempt to recover monetary damages from those responsible for your child’s injury.

Contact us Today for a Free Consultation!

For a free consultation with an experienced medical malpractice attorney in Michigan, contact Buchanan Firm. We can discuss your situation if you believe your child has been injured as the result of a brachial plexus injury.

Our firm proudly serves people all across Michigan, including major cities like Grand Rapids, Muskegon, Detroit, Lansing, Holland, St. Joe, and Ann Arbor, and rural towns such as Lowell, Ada, Fremont, Newaygo, Grand Haven, Rockford, and Cedar Springs. We will meet you after-hours, at home or in the hospital to accommodate you.