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What is brachial plexus?

The brachial plexus is a network of nerves that connects the brain to the arm and hand. Messages from the brain to the arm travel through the spinal cord and exit through five different levels of the spinal cord: cervical levels 5, 6, 7, 8 and thoracic level 1. These five main nerve roots create the network of nerves known as the brachial plexus. Plexopathy refers to injury of this network of nerves.

 

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What causes brachial plexus injuries?

(Harris B. Shoulder dystocia. Clinical Obstetrics and Gynecology; 1984, 27:106. Used with permission.) During birth, the baby's neck and shoulders may stretch too far apart, injuring the nerves.

Most brachial plexus injuries happen during birth, although a brachial plexus injury can occur at any time. Many babies with brachial plexus injuries are larger than average at birth. However, newborns of all sizes can have these injuries, even premature babies.

The injury occurs when the baby is passing through the birth canal. The baby's shoulders may become impacted, causing the brachial plexus nerves to stretch or tear.

Approximately 2 babies in 1,000 experience brachial plexus injuries at birth. About 1 in 10 of these babies need surgical treatment, with the others recovering full nerve function through therapeutic exercises alone.

Brachial plexus injuries also occur in children or adults due to trauma to the neck or shoulder region, commonly from motorcycle or motor-vehicle accidents.

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What to look for if you suspect your child has a brachial plexus injury

Children with brachial plexus injuries are affected in different ways. Here are some examples:

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

Specifically, at 3 months of age, if your child cannot: squeeze your fingers, bend their wrist, bend and straighten their elbow, or raise their arm, it is recommended that you seek a referral to a brachial plexopathy clinic for further evaluation. Treatment for brachial plexus injuries is most effective when initiated between 3 and 6 months of age.

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Treatment options for brachial plexus injuries

There are two main treatments for brachial plexus injuries:

• physical or occupational therapy exercises
• surgery plus therapy exercises

Most children will regain full use of their motor function through therapy alone. For those children who do not regain their motor function by 3-6 months of age, nerve surgery can be an effective treatment to improve arm function following a brachial plexus injury.

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Brachial Plexopathy Clinic

Gillette Children's Specialty Healthcare offers a comprehensive program for evaluating and treating brachial plexus injuries.

Our pediatric specialists include:

• neurologists
• physical and occupational therapists
• orthopaedic surgeons
• neurosurgeons

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Resources

United Brachial Plexus Network - The United Brachial Plexus Network strives to inform, support and unite families and those concerned with brachial plexus injuries worldwide.
http://www.ubpn.org/

 

Related Information:

Center for Pediatric Orthopaedics | Pediatric Neurosurgery | Brachial Plexus Clinic